E-CONSULTS FOR OUTPATIENT GASTROENTEROLOGY REFERRALS IMPROVE PATIENT OUTCOMES, DECREASE PATIENT WAIT TIMES, AND DECREASE RESOURCE UTILIZATION

ABSTRACT

Introduction Traditional methods of addressing gastroenterology referrals involve giving the referred patient an in office clinic appointment and waiting until the appointment to make consultant recommendations. In September 2019 (prior to the COVID-19 pandemic), our institution started an e-consult system for gastroenterology referrals where every referral was reviewed by a gastroenterologist and decision was made to direct the patient to telemedicine visit or in office visit. We aim to compare the outcomes of this e-consult system with traditional referral response methods. Methods Retrospective cohort study comparing econsults with traditional methods. We randomly selected 350 referrals from September 2019 through January 2020 to form the e-consult cohort and 350 referrals from January 2018 through May 2019 to form the traditional methods cohort. Outcomes of primary interest were observed for one month after referral. Primary outcome was number of patients with emergency department (ED) visits and hospitalizations for primary gastroenterology complaints within 30 days of referral. Secondary outcomes included mean time to first consultant recommendations, endoscopies, and in-person appointments. First consultant recommendations are defined as the first instance of recommendations (such as labs, imaging, endoscopy, or verbal instruction to the patient or referring physician) by a gastroenterology provider pertaining to the referring question after initial referral. Results E-consults were associated with significantly fewer ED visits (4% vs 7.7%, P=0.036) and fewer hospitalizations (1.4% vs 4.3%, p=0.023) within 30 days of referral. E-consults resulted in significantly higher proportion referrals receiving consultant recommendations within 30 days (87% vs 39%, P<0.01). Recommendations were also made in significantly less time with e-consults (4.3 vs 42 days, P<0.01). E-consults were also associated with a greater proportion for endoscopy performed within 30 days (17% vs 4%, P<0.01). Endoscopies were able to be performed in significantly less time after referral with e-consults (61 vs 96 days, P<0.01). Conclusions Gastroenterology referrals seen with e-consults were associated with significantly fewer ED visits and hospitalizations within 30 days of referral when compared to traditional methods. E-consults were also associated with dramatically shorter wait time for consultant recommendations and endoscopies as well as decreased need for in-person clinic appointments. (Table Presented) (Table Presented)