Observational Study

. 2018 Jan 10;13(1):e0190247.

doi: 10.1371/journal.pone.0190247. eCollection 2018.

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

Lillian Lai¹, Clare Liddy², Erin Keely³, Amir Afkham⁴, Julia Kurzawa⁵, Nishard Abdeen⁶, Tobey Audcent⁷, Matthew Bromwich⁸, Jason Brophy⁹, Sasha Carsen¹⁰, Annick Fournier¹¹, Leigh Fraser-Roberts⁷, Hazen Gandy¹², Charles Hui⁹, Donna Johnston¹³, Kathryn Keely¹⁴, Ken Kontio¹⁰, Christine Lamontagne¹⁵, Nathalie Major⁷, Michael O'Connor¹¹, Dhenuka Radhakrishnan¹⁶, Joe Reisman¹⁶, Marjorie Robb¹², Lindy Samson⁹, Erick Sell¹⁷, William Splinter¹⁸, Judy van Stralen⁷, Sunita Venkateswaran¹⁷, Kimmo Murto¹⁹

Affiliations

¹ Department of Pediatrics, Division of Cardiology, Children's Hospital of Eastern Ontario-Ottawa Children's Treatment Center (CHEO-OCTC), University of Ottawa, Ottawa, Ontario, Canada.
² Department of Family Medicine; C.T. Lamont Primary Healthcare Research Centre, Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
³ Department of Medicine, Division of Endocrinology and Metabolism, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
⁴ The Champlain Local Health Integration Network, Ottawa, Ontario, Canada.
⁵ CHEO Research Institute, Ottawa, Ontario, Canada.
⁶ Department of Medical Imaging, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
⁷ Department of Pediatrics, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
⁸ Department of Surgery, Division of Otolaryngology, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
⁹ Department of Pediatrics, Division of Infectious Diseases, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹⁰ Department of Surgery, Division of Orthopedics, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹¹ Department of Ophthalmology, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹² Department of Psychiatry, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹³ Department of Pediatrics, Division of Hematology and Oncology, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹⁴ Department of Pediatrics, Division of Community Pediatrics, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹⁵ Department of Anesthesiology and Pain Medicine, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹⁶ Department of Pediatrics, Division of Pulmonology, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹⁷ Department of Pediatrics, Division of Neurology, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹⁸ Department of Anesthesiology and Pain Medicine, CHEO-OCTC, Roger Neilson's House, Palliative Care Program, University of Ottawa, Ottawa, Ontario, Canada.
¹⁹ Department of Anesthesiology and Pain Medicine, CHEO-OCTC, CHEO Research Institute, University of Ottawa, Ottawa, Ontario, Canada.

PMID: 29320539
PMCID: PMC5761872
DOI: 10.1371/journal.pone.0190247

Observational Study

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

Lillian Lai et al. PLoS One. 2018.

. 2018 Jan 10;13(1):e0190247.

doi: 10.1371/journal.pone.0190247. eCollection 2018.

Authors

Affiliations

¹ Department of Pediatrics, Division of Cardiology, Children's Hospital of Eastern Ontario-Ottawa Children's Treatment Center (CHEO-OCTC), University of Ottawa, Ottawa, Ontario, Canada.
² Department of Family Medicine; C.T. Lamont Primary Healthcare Research Centre, Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
³ Department of Medicine, Division of Endocrinology and Metabolism, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
⁴ The Champlain Local Health Integration Network, Ottawa, Ontario, Canada.
⁵ CHEO Research Institute, Ottawa, Ontario, Canada.
⁶ Department of Medical Imaging, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
⁷ Department of Pediatrics, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
⁸ Department of Surgery, Division of Otolaryngology, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
⁹ Department of Pediatrics, Division of Infectious Diseases, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹⁰ Department of Surgery, Division of Orthopedics, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹¹ Department of Ophthalmology, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹² Department of Psychiatry, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹³ Department of Pediatrics, Division of Hematology and Oncology, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹⁴ Department of Pediatrics, Division of Community Pediatrics, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹⁵ Department of Anesthesiology and Pain Medicine, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹⁶ Department of Pediatrics, Division of Pulmonology, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹⁷ Department of Pediatrics, Division of Neurology, CHEO-OCTC, University of Ottawa, Ottawa, Ontario, Canada.
¹⁸ Department of Anesthesiology and Pain Medicine, CHEO-OCTC, Roger Neilson's House, Palliative Care Program, University of Ottawa, Ottawa, Ontario, Canada.
¹⁹ Department of Anesthesiology and Pain Medicine, CHEO-OCTC, CHEO Research Institute, University of Ottawa, Ottawa, Ontario, Canada.

PMID: 29320539
PMCID: PMC5761872
DOI: 10.1371/journal.pone.0190247

Abstract

Background: 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.

Objective: 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.

Design: Prospective observational cohort study.

Setting: Single Canadian tertiary-care academic pediatric hospital (June 2014-16) servicing 1.2 million people.

Participants: 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.

Main outcomes and measures: Specialty service utilization and access, impact on PCP course-of-action and referral-patterns and survey-based provider satisfaction data were collected.

Results: 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.

Conclusions and relevance: 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.

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Conflict of interest statement

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Drs. Leigh Fraser Roberts, Kathy Keely and Judy Van Stralen were paid directly for their services by eConsult during the study period. The rest of the authors have no financial relationships relevant to this article to disclose. The authors have no other conflicts of interest related to activities, relationships and affiliations to disclose involving the work under consideration for publication. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

**Fig 1. Impact on course of action by the primary care practitioner, by specialty service with > 10 cases.**
Impact of specialist response on PCP course of action: (Blue) Provided new information and/or additional course of action; (Red) Confirmed course of action; (Green) Considered not useful and (Purple) Other.

**Fig 2. Impact on need for referral as indicated by primary care practitioner, by specialty service with > 10 cases.**
Impact of specialist response on PCP perceived need for patient referral: (Light Blue) Referral avoided; (Orange) Referral still not needed; (Gray) Referral still needed; (Yellow) New referral needed; (Dark Blue) No benefit and (Green) Other.

See this image and copyright information in PMC

References

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical