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. 2024 May 16:26:e55623.
doi: 10.2196/55623.

Implementation of Inpatient Electronic Consultations During the COVID-19 Crisis and Its Sustainability Beyond the Pandemic: Quality Improvement Study

Anna S Aledia  1 , Amish A Dangodara  1 , Aanya A Amin  1 , Alpesh N Amin  1
Affiliations

Implementation of Inpatient Electronic Consultations During the COVID-19 Crisis and Its Sustainability Beyond the Pandemic: Quality Improvement Study

Anna S Aledia et al. J Med Internet Res. .

Abstract

Background: Limiting in-person contact was a key strategy for controlling the spread of the highly infectious novel coronavirus (COVID-19). To protect patients and staff from the risk of infection while providing continued access to necessary health care services, we implemented a new electronic consultation (e-consult) service that allowed referring providers to receive subspecialty consultations for patients who are hospitalized and do not require in-person evaluation by the specialist.

Objective: We aimed to assess the impact of implementing e-consults in the inpatient setting to reduce avoidable face-to-face referrals during the COVID-19 pandemic.

Methods: This quality improvement study evaluated all inpatient e-consults ordered from July 2020 to December 2022 at the University of California Irvine Medical Center. The impact of e-consults was assessed by evaluating use (eg, number of e-consults ordered), e-consult response times, and outcome of the e-consult requests (eg, resolved electronically or converted to the in-person evaluation of patient).

Results: There were 1543 inpatient e-consults ordered across 11 participating specialties. A total of 53.5% (n=826) of requests were addressed electronically, without the need for a formal in-person evaluation of the patient. The median time between ordering an e-consult and a specialist documenting recommendations in an e-consult note was 3.7 (IQR 1.3-8.2) hours across all specialties, contrasted with 7.3 (IQR 3.6-22.0) hours when converted to an in-person consult (P<.001). The monthly volume of e-consult requests increased, coinciding with surges of COVID-19 cases in California. After the peaks of the COVID-19 crisis subsided, the use of inpatient e-consults persisted at a rate well above the precrisis levels.

Conclusions: An inpatient e-consult service was successfully implemented, resulting in fewer unnecessary face-to-face consultations and significant reductions in the response times for consults requested on patients who are hospitalized and do not require an in-person evaluation. Thus, e-consults provided timely, efficient delivery of inpatient consultation services for appropriate problems while minimizing the risk of direct transmission of the COVID-19 virus between health care providers and patients. The service also demonstrated its value as a tool for effective inpatient care coordination beyond the peaks of the pandemic leading to the sustainability of service and value.

Keywords: COVID-19; consultations; coronavirus; e-consult; eConsult; effectiveness; electronic consultation; health care; health care providers; infectious; inpatient; novel coronavirus; pandemic; patient; patients; staff; tool; tools.

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Conflict of interest statement

Conflicts of Interest: ANA has been a principal investigator or coinvestigator of clinical trials sponsored by the National Institutes of Health/National Institute of Allergy and Infectious Diseases, NeuroRx Pharma, Pulmotect, Blade Therapeutics, Novartis, Takeda, Humanigen, Eli Lilly, PTC Therapeutics, OctaPharma, Fulcrum Therapeutics, and Alexion, as well as a speaker and consultant for BMS, Pfizer, BI, Portola, Sunovion, Mylan, Salix, Alexion, AstraZeneca, Novartis, Nabriva, Paratek, Bayer, Tetraphase, Achogen LaJolla, Ferring, Seres, Spero, Eli Lilly, Gilead, Millenium, HeartRite, Aseptiscope, and Sprightly; these relationships were unrelated to the current work. ASA, AAD, and AAA have no conflicts of interest to report.

Figures

Figure 1
Figure 1
Workflows for requesting and responding to inpatient e-consults. e-consult: electronic consultation; EHR: electronic health record.
Figure 2
Figure 2
e-Consult and traditional in-person consult volume by specialty. Percentages of e-consults (blue) and traditional in-person consults (gray) requested by specialty are shown on the primary axis. Total consult orders (e-consult and traditional in-person consults) by specialty are shown on the secondary axis. e-consult: electronic consultation.
Figure 3
Figure 3
e-Consult response times by specialty. Boxplot of response times by specialty for e-consult requests resolved electronically (orange) and converted to in-person (teal). The box represents the IQR, with the top and bottom of box corresponding to the upper (third) and lower (first) quartiles, respectively. The horizontal line inside the box marks the median and the lines extending out from the box (whiskers) represent values within 1.5 times the IQR. For reference, the median response time for completion of a traditional in-person consult is marked by the dashed red line. *Indicates statistical significance.
Figure 4
Figure 4
e-Consult volume over time. Monthly e-consult orders for ambulatory (green) and inpatient (red) settings at the University of California Irvine (UCI), 2015-2022. UCI transitioned from the Allscripts electronic health record platform to Epic in fall 2017. Launch dates for ambulatory and inpatient e-consults were April 2015 and July 2020, respectively. e-consult: electronic consultation; EHR: electronic health record.
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