A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield

• Published in: BMC health services research Vol. 17; no. 1; p. 433
• Main Authors: Ulloa, Jesus G, Russell, Marika D, Chen, Alice Hm, Tuot, Delphine S
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 23-06-2017; BioMed Central; BMC
• Subjects: Accountable care organizations; Adult; Ambulatory care; Ambulatory Care Facilities; Ambulatory safety; Analysis; Cholecystectomy; Clinics; Cohort analysis; Communication; Continuity of care; Electronic consultation; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - standards; Female; General Surgery - standards; Health care; Health services; Health system redesign; Hernias; Hospitals; Humans; Laparoscopy; Male; Medical equipment industry; Medical records; Medical referrals; Middle Aged; Morbidity; Pain; Patient Safety; Patient Satisfaction; Patient-centered care; Patient-centered medical neighborhood; Patients; Physicians; Primary care; Primary Health Care - methods; Primary Health Care - standards; Quality; Referral and Consultation - organization & administration; Referral and Consultation - standards; Remote Consultation - standards; Retrospective Studies; Safety and security measures; Schedules; Scheduling; Specialization; Surgeons; Surgery; Surgical yield; Surgical yield; Patient-centered medical neighborhood; Electronic consultation; Health system redesign; Ambulatory safety
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-017-2375-0

Electronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case).
Retrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014. Electronic consultation requests were reviewed for the presence/absence of consult domains: symptom acuity/severity, diagnostic evaluation, concurrent medical conditions, and attempted diagnosis. Logic regression was used to examine the association between completeness of consult requests and scheduling an ambulatory clinic visit. Surgical yield was also calculated, as was the percentage of patients requiring unanticipated healthcare visits.
In 2014, 1743 electronic consultations were submitted to general surgery. Among the 150 abstracted, the presence of consult domains ranged from 49% to 99%. Consult completeness was not associated with greater likelihood of scheduling an ambulatory visit. Seventy-six percent of consult requests (114/150) were scheduled for a clinic appointment and surgical yield was 46%; without an eConsult system, surgical yield would have been 35% (p=0.07). Among patients not scheduled for a clinic visit (n=36), 4 had related unanticipated emergency department visits.
Econsult systems can be used to safely optimize the surgical yield of a safety-net general surgery service.