How useful and appropriate are electronic consultations?

Novel metrics used to evaluate the appropriateness and utility of electronic consultations (e-consults) deliver meaningful insights into clinical practice and offer a rubric for comparison in future studies in additional settings, as well as suggest areas for improvement of resource use and patient care, reports a recent study.

In total, 1,096 referring providers made 6,512 eligible e-consults to 121 specialist consultants. Inquiries were diagnostic, therapeutic, for provider education or at the request of the patient. Consultations varied across specialties (73.1 percent for psychiatry to 87.8 percent for infectious disease), but most were answered within a day.

Of the total e-consults, 70.2 percent met all four criteria for appropriateness: not answerable by reviewing evidence-based summary sources (“point-of-care resource test”), not merely requesting logistic information, having appropriate clinical urgency, and having appropriate patient complexity. The frequency of unmet criteria differed among specialties.

Ninety-four percent of these e-consults were deemed appropriate by raters (κ, 0.57, 95 percent confidence interval, 0.36–0.79), indicating moderate agreement. Across specialties, avoided visits had an overall rate of 81.2 percent, with the highest rate in psychiatry (92.6 percent) and the lowest in dermatology (61.9 percent).

Patients with e-consult requests to five specialties (ie, haematology, infectious disease, dermatology, rheumatology and psychiatry) between October 2017 and November 2018 were included in this retrospective cohort study conducted at two large academic and two community hospitals of an integrated health system.

The investigators assessed the appropriateness of e-consult inquiries by reviewing medical records. Inter-rater agreement in assessments of e-consult appropriateness was assessed using the κ statistic. The rate of avoided visits, defined by the absence of an in-person visit to the same specialty within 120 days, was used to evaluate the utility of e-consults.