Journal Article

The impact of electronic consultation on a Canadian tertiary care pediatric specialty referral system: A prospective single-center observational study

Reisman, Joe, Venkateswaran, Sunita, van Stralen, Judy, Kontio, Ken, Liddy, Clare, Abdeen, Nishard, Brophy, Jason, Sell, Erick, Murto, Kimmo, Keely, Kathryn, Samson, Lindy, Keely, Erin, Audcent, Tobey, Major, Nathalie, Hui, Charles, Radhakrishnan, Dhenuka, Johnston, Donna, Robb, Marjorie, Lai, Lillian, Bromwich, Matthew, Fraser-Roberts, Leigh, Fournier, Annick, Lamontagne, Christine, O’Connor, Michael, Kurzawa, Julia, Gandy, Hazen, Afkham, Amir, Splinter, William, Carsen, Sasha

2018

Overview

Champlain BASE™ (Building Access to Specialists through eConsultation) is a web-based asynchronous electronic communication service that allows primary-care- practitioners (PCPs) to submit \"elective\" clinical questions to a specialist. For adults, PCPs have reported improved access and timeliness to specialist advice, averted face-to-face specialist referrals in up to 40% of cases and high provider satisfaction. To determine whether the expansion of eConsult to a pediatric setting would result in similar measures of improved healthcare system process and high provider acceptance reported in adults. Prospective observational cohort study. Single Canadian tertiary-care academic pediatric hospital (June 2014-16) servicing 1.2 million people. 1. PCPs already using eConsult. 2.Volunteer pediatric specialists provided services in addition to their regular workload. 3.Pediatric patients (< 18 years-old) referred for none-acute care conditions. Specialty service utilization and access, impact on PCP course-of-action and referral-patterns and survey-based provider satisfaction data were collected. 1064 eConsult requests from 367 PCPs were answered by 23 pediatric specialists representing 14 specialty-services. The top three specialties represented were: General Pediatrics 393 cases (36.9%), Orthopedics 162 (15.2%) and Psychiatry 123 (11.6%). Median specialist response time was 0.9 days (range <1 hour-27 days), most consults (63.2%) required <10minutes to complete and 21/21(100%) specialist survey-respondents reported minimal workload burden. For 515/1064(48.4%) referrals, PCPs received advice for a new or additional course of action; 391/1064(36.7%) referrals resulted in an averted face-to-face specialist visit. In 9 specialties with complete data, the median wait-time was significantly less (p<0.001) for an eConsult (1 day, 95%CI:0.9-1.2) compared with a face-to-face referral (132 days; 95%CI:127-136). The majority (>93.3%) of PCPs rated eConsult as very good/excellent value for both patients and themselves. All specialist survey-respondents indicated eConsult should be a continued service. Similar to adults, eConsult improves PCP access and timeliness to elective pediatric specialist advice and influences their care decisions, while reporting high end-user satisfaction. Further study is warranted to assess impact on resource utilization and clinical outcomes.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adults / Analysis / Anesthesiology / Biology and Life Sciences / Consultation / Decision making / Ecology and Environmental Sciences / Health aspects / Health care / Health care reform / Hematology / Hospitals / Infectious diseases / Medicine / Medicine and Health Sciences / Observational studies / Orthopedics / Pain / Patients / Pediatrics / People and places / Physicians / Primary care / Psychiatry / Research and Analysis Methods / Resource utilization / Response time / Surgery / Telemedicine / User satisfaction / Working conditions / Workload