ASSESSING THE UTILIZATION OF INPATIENT ECONSULTS DURING COVID-19

ABSTRACT

BACKGROUND: Electronic consultations (eConsults) are formal, asynchronous clinical consultations between primary care providers and specialists. With increasing implementation of inpatient eConsult programs, studies have classified the most frequently consulted departments and reported hospitalist satisfaction, with logistic discussion of inpatient eConsults. However, there are no studies analyzing the time to inpatient eConsult response and the prevalence of COVID-19 in eConsult patients. METHODS: A retrospective chart review of inpatient eConsults at a single U.S. tertiary care medical center from 3/26/20 to 10/8/20. We reviewed patient demographics, COVID-19 status, type of consult question, time to response, conversion rate to a face-to-face visit, and recommendation for outpatient specialty follow-up. RESULTS: There were 538 documented eConsults for 417 patients, with an average age of 52.8 years, 59.0% male, 72.9% white. The most frequently eConsulted departments were Physical Medicine and Rehabilitation (25.7%), Hematology Oncology (13.2%), and Cardiology (7.80%). Inpatient eConsults were predominately regarding patient management questions (87.9%), compared to questions about diagnosis (14.3%) and interpretation of labs or imaging (14.9%). eConsults with multiple question types (15.8%) were more frequent than previously observed in studies of outpatient eConsults. The majority of eConsults were answered and resolved by specialists after one note (61.7%);however, 34.9% of eConsults were followed virtually with multiple notes, and 3.35% were converted to face-to-face consults. Outpatient specialty follow-up was recommended in 12.6% of eConsults. Only 92 (17%) eConsults were linked to orders, enabling measurement of the time the note was signed by the consultant attending physician. The median time from eConsult order until the attending note signature was 14.1 hours. 65.2% of these eConsults had a response within 1 day. 68 study patients (16.3%) were hospitalized with COVID-19, comprising 123 (22.9%) inpatient eConsults. 1.63% of COVID-19 eConsults were converted to face-to-face consultations versus 3.86% of non-COVID-19 eConsults. 72 patients (17.3%) had multiple eConsults, with 39 (9.35%) of these patients having eConsults to multiple different specialties. Of these 39 patients, 21 had COVID-19 during their hospitalization, a higher proportion than the nonCOVID-19 cohort, χ2 (1, N = 417) = 28.083, p < 0.001. CONCLUSIONS: Evaluation of our inpatient eConsult program demonstrates that the majority of eConsults were regarding patient management, with few consults requiring conversion to face-to-face encounters. The findings also reveal an association of multiple specialty eConsults for COVID19 patients. Additionally, inpatient eConsults provide an avenue for reducing consultant exposure to COVID-19. Further efforts can focus on improving the workflow in an effort to optimize consultant response times and assessing the conclusion of outpatient specialty follow-up recommendations.