Electronic Consultations in a Community Neurology Practice: Assessment of Safety and Risk Factors for Subsequent Face-to-Face Neurological Consultation (P6-7.005)

Abstract

<h3>Objective:</h3> We aim to describe our practice’s use of electronic consultations (e-consults) and assess safety and risk factors for subsequent face-to-face consultations (FTF-consults). <h3>Background:</h3> The application of e-consults is a growing practice utilized to improve access to neurological expertise. Safety and outcomes of e-consults have not been well studied. <h3>Design/Methods:</h3> A retrospective cohort study of all e-consults completed in a community neurology practice between May 5, 2018 to June 31, 2019, was completed. Clinical and demographic variables were compared between the successful and unsuccessful (defined by presence of subsequent FTF-consult) cohorts. Hazard ratios (HR) were calculated using Cox regression model. Kaplan-Meier probability analysis (with 95% confidence interval) of subsequent FTF-consult was performed. Case examples highlighting potential harm were summarized. <h3>Results:</h3> 302 e-consults were reviewed. The median time from e-consult order to completion was 3 days. The median age was 53 years and 68.5% were female. Most referring providers were attending physicians (51.3%), followed by advanced practice providers (34.1%) and resident trainees (14.6%). The most frequent referrals were for headache (n=125, 41.4%), dysesthesia (n=40, 13.2%), and abnormal imaging finding (n=27, 8.9%). The most common e-consult questions were for treatment (57.6%) and diagnostic evaluation (48.0%) recommendations. 24.8% of e-consults were followed by FTF-consults. Primary risk factors associated with subsequent FTF-consult included female sex (HR=1.9), referral for headache (HR=1.7), and final diagnosis of migraine (HR=2.0) or chronic migraine (HR 5.0). Potential harm related to delayed diagnosis/treatment was identified in 6 (2.0%) patients with migraine and 4 (1.3%) without migraine presenting to emergency department. <h3>Conclusions:</h3> Utilization of e-consults may safely improve access to neurological expertise. In patients with chronic migraine, e-consults should be considered short-term and followed by FTF-consult as soon as access allows. Neurologists performing e-consults should be able to triage patients to FTF-consults, particularly when diagnosis is uncertain or the neurological examination may help guide appropriate testing. <b>Disclosure:</b> Dr. Seven has nothing to disclose. Dr. Young has nothing to disclose. Dr. Truitt has stock in NVTA. Dr. Truitt has stock in QTRX. Dr. Truitt has stock in EXAS. Dr. Truitt has stock in ALC. Dr. Truitt has stock in ACAD. Dr. Truitt has stock in ABBV. Dr. Truitt has stock in NVS. Dr. Truitt has stock in VRTX. Dr. Truitt has stock in MRK. Dr. Truitt has stock in ATRI. Dr. Truitt has stock in HZNP. Dr. Truitt has stock in ZM.