Background: The Veterans Affairs Boston Healthcare System (VABHS) has embraced electronic consults (EC) as a way to improve access to subspecialty care. VABHS is a large tertiary care facility, receiving Infectious Disease (ID) consults from acute inpatient settings, long term care facilities (LTCF), and outpatient clinics across New England. EC are asynchronous, consultative, provider-to-provider communications mitigating the need for a face-to-face (FTF) visit. The scope and impact of EC on FTF consultation in ID is not well described.
Methods: The reason and frequency of consults in 2011 (FTF only) was compared to that in 2014 (FTF and EC).
Results: There were 193 FTF consults in 2011 compared to 195 in 2014 (during this time the total number of inpatient hospitalizations and outpatient visits at the medical center remained unchanged). Of 308 EC in 2014, the largest group of questions (26%) included questions related to antimicrobial use for bacterial infections (fig 1). Frequency of e-consult versus FTF for Lyme disease, UTI, C diff, perioperative antibiotics, and immunization were significantly higher (p <.05 for each) compared to FTF. EC were utilized more than FTF by LTC facilities [45 (14.8%) EC vs. 6 (3%) FTF] and non-Boston facilities [69 (22%) EC vs. 14 (7%) FTF]. 98% of EC were done by 1 designated provider.
Conclusion: The implementation of EC did not result in a compensatory decrease in the number of FTF consults. As such, the EC may represent new consultative work for the ID specialist. Whether this increased specialty involvement in care leads to improved outcomes remains to be evaluated. The EC turnaround time is significantly shorter than FTF; this may be augmented by a dedicated EC physician. Certain diagnoses such as UTI, noninvasive bacterial infections, perioperative surgical antibiotic management rarely trigger a FTF, but generate many EC, providing an opportunity to enhance antibiotic stewardship.
K. Gupta, None
E. J. Kim, None
V. Vimalananda, None
K. Devito, None
S. R. Simon, None
J. Orlander, None
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