THE USE OF E-CONSULTATION FOR PEDIATRIC UROLOGY OUTPATIENT REFERRALS
Nadia Valeska Halstead, MD, MPH1, Marguerite Korber, CPNP2, Matthew Thompson, MBA1, John Thomas, PhD1, Kyle Rove, MD1.
1University of Colorado, Aurora, CO, USA, 2Children's Hospital of Colorado, Aurora, CO, USA.
BACKGROUND:Referrals to pediatric urology for non-surgical conditions have increased in recent years, and quality of communication between primary care providers (PCPs) and specialists has decreased. These effects open the door for innovative telehealth measures such as e-consults, which allow PCPs to send non-urgent clinical questions to specialists and avoid unnecessary escalation of care.
The University of Colorado School of Medicine and Children’s Hospital Colorado implemented Project CORE (responsible for the e-consult process), aiming to improve care quality and patient experience while reducing cost by enhancing communication between PCPs and specialty physicians.
We aim to describe our early experience in using e-consultation in pediatric urology , specifically examining reasons for referral, need for in-person visit, and time spent. We hypothesize that e-consults decrease unnecessary subspecialty visits for common non-surgical conditions.
METHODS:We performed a retrospective review of all patients who had an e-consult and traditional electronic referral to pediatric urology from 06/2019 to 07/2021 (COMIRB approval #20-0552). To enter an e-consult, primary care providers enter an electronic medical record order entitled “Pediatric Urology E-Consult,” and it presents a template to collect information for the following pediatric urology scenarios: frequency/urgency, hematuria, hydronephrosis, nephrolithiasis, nocturnal enuresis, recurrent urinary tract infections, varicocele, and other. Additional laboratory or pertinent radiologic information deemed relevant is automatically appended and then forwarded to the urology team electronically, with response time goal under 48 hours. Patient demographics, reason for e-consult, and referral outcome were all recorded.
RESULTS:There were 105 e-consults (12.2%) and 750 traditional electronic referrals (87.7%) to our outpatient pediatric urology clinic over the 25-month period from within our hospital network and extended network of PCPs. Residents were the only providers more likely to utilize the e-consult system (62.5%) versus traditional referral. 95% of referrals did not use the preformatted list of diagnoses and instead used an open-ended template. The majority of e-consults (60.9%) were completed in 5-10 minutes. The median response time was < 1 day (range 0-14). Only 7 e-consults (6.6%) were converted to in-person referrals.
CONCLUSIONS:E-consults appeared to be a time-effective management of simple clinical scenarios for both patient (avoiding a trip to pediatric urology clinic) and PCP. Given that small percentage of the e-consults were converted to traditional in-person referrals, we see great potential in utilizing e-consults, as this may help increase patient satisfaction, decrease clinic wait, and increase the proportion of clinically-meaningful subspecialty visits.
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