Abstract 143: Electronic Consultation for Outpatient Stroke/TIA Care: Are Recommendations Followed?

Abstract

Background: Including electronic consultations (e-consults) in addition to video visits in a teleneurology program can improve patient access and allow early recommendations (recs) to be communicated to referrers of patients with prior stroke/TIA. We sought to compare how attention to recs differed by type of teleneurology care. Methods: We evaluated outpatient video and e-consults for Veterans with stroke/TIA receiving care in the VA National TeleNeurology Program from 12/2022-4/2023. E-consults were completed if relevant records were available in the electronic health record (EHR). Video consults were scheduled as part of the NTNP. Clinical information, recs (categorized by type), and subsequent orders were assessed with EHR data and chart review. Rec attention was defined as ordered or completed within 60 days of a completed consult. We used two-sided two-sample t-tests, two-sample Wilcoxon rank sum tests and chi-square tests to compare demographics and rec attention rates between e-consult and video groups. Results: Of 391 consults requested for a stroke/TIA diagnosis, 214 (55%) had a neurologist stroke/TIA diagnosis and at least one rec; 57 (27%) of these were e-consults. Patients were similar in both groups (Table); e-consults were completed faster (mean 3.9 days vs. 60.3 days). E-consults had a similar number of recs (mean 2.2 recs vs 1.9 per consult, p = 0.17) but slightly more imaging recs (0.89 vs 0.62 per consult, p = 0.04). Overall, e-consult recs were less likely to receive attention: 55% in e-consult vs 69%, p = 0.05; this gap was worst for attention to lab recs (40% vs 70%, p = 0.03). Conclusion: E-consults for outpatient stroke/TIA questions can improve the timeliness of care, but recs are less likely to be followed than if care is directly provided via telehealth video visits. Consideration for care models that improve communication between the neurologist and the referrer may be necessary to improve attention to consult recommendations.