Abstract 189: Electronic Consults and Active Referral Management for Improving Access to Specialty Care Within the Veterans Health Administration

Abstract

Background: Electronic consultations (e-consults) are a novel approach to patient care that may improve access to specialty care by reducing the burden on outpatient clinics. We adopted e-consults within an active referral management (ARM) process for our Veterans Health Administration (VHA) outpatient cardiology clinic to reduce clinic wait times. Methods: Our ARM process consisted of reviewing all incoming consult requests for our outpatient clinic and triaging the requests to either an e-consult or a clinic visit. This occurred in two phases, triaged by physician alone in the first phase (11/1/15 to 10/30/16) and by a non-physician provider/provider dyad (11/1/16 to 3/1/17) in the second phase. Results: The primary outcome was wait time for an appointment in our clinic. A secondary analysis of consult requests was reviewed to determine the proportions of ordering specialties, reasons for consults, and the result of the ARM triage. The median wait time for our clinic prior to adopting e-consults and the ARM process was 24 days. In phase 1, we observed 20 weeks of wait times below the median and the wait time was calculated to be 13 days (46% reduction). In phase 2, we observed a significant increase in both overall consult volume and in wait times. Approximately 60% of incoming consults could be triaged into e-consults, predominantly by managing stable diseases or minor symptoms. Conclusions: E-consults and ARM of clinical referrals were effective at reducing wait times for outpatient VHA cardiology clinic. The majority of clinical referrals could be handled through e-consult and did not require an in-person clinic visit.