Evaluating efficiency of electronic consult requests in an outpatient classical hematology clinic.

Abstract

46 Background: The classical hematology department at Beth Israel Deaconess Medical Center had 2,200 new outpatient consults in 2022. The conventional process for initiating consults was provider dependent, involving emails to practice hematologists and calls to clinic. Without a standardized process of requesting consults and providing relevant data, providers are not able to efficiently prepare for new visits, which can lead to patient/provider dissatisfaction and repetitive visits. Methods: As a convenience baseline sample in January 2023, hematology-oncology fellows were asked how often they were able to determine the consult reason in coagulation clinic, using a 5-point Likert scale. On 2/1/23, an electronic consult request became available to referring providers within the electronic medical record, and fellows received shared access of the consult list. Following the interventions, fellows were asked how often they were able to determine the consult reason and how often they utilized the electronic order and shared consult list. An additional metric included how often a follow up visit was needed due to insufficient information prior to the appointment. Results: Prior to the intervention, 212 new consults were requested in January 2023. Since the intervention, there have been 963 new consults requested in 115 days, 291 of which were submitted by electronic request [30.2%]. Prior to the intervention, fellows rated ease of finding the consult question an average of 2.2 with median 2.0 on a 5-point Likert scale (1=very difficult, 5=very easy). After addition of the electronic consult request, the average rating improved to 3.75 with median 4.0. To determine the consult question after the intervention, fellows utilized various resources including the new electronic order (28.6%), shared consult list (71.4%) and scanned records or forward emails (42.9%). Prior to the intervention, 3/20 [15%] classical hematology patients in a convenience sample required a follow up visit due to insufficient information available to the provider pre-initial visit. This improved to 0/20 patients after the intervention. Conclusions: Adding electronic consult requests and sharing referral reasons with the entire clinical team improved provider satisfaction with new visits and decreased need for repeat visits. However, utilization of a new electronic consult request by referring physicians remains low. Next steps include efforts to increase electronic consult request use, so that classical hematology clinic visits can be more efficient, which is essential to patient and staff satisfaction and value-based healthcare. [Table: see text]