JMIR Publications

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 healthcare services, we implemented a new electronic consultations (eConsults) service that allowed referring providers to receive subspecialty consultations for hospitalized patients who don’t require in-person evaluation by the specialist.

Objective:

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

Methods:

This quality improvement study evaluated all inpatient eConsults ordered from July 2020 to December 2022 at the University of California Irvine medical center. Impact of eConsults was assessed by evaluating usage, (e.g., number of eConsults ordered), eConsult response times, and outcome of the eConsult requests (e.g., resolved electronically or converted to in-person evaluation of patient).

Results:

There were 1,543 inpatient eConsults ordered across 11 participating specialties. Approximately 54% (826/1543) of requests were addressed electronically, without the need for a formal, in-person evaluation of the patient. The median time between ordering an eConsult and a specialist documenting recommendations in an eConsult note was 3.7 hours (Interquartile Range, IQR: 1.3-8.2) across all specialties, contrasted with 7.3 hours (IQR: 3.6-22.0) when converted to an in-person consult (P<.001). The monthly volume of eConsult requests increased, coinciding with surges of COVID-19 cases in California. After the peaks of the COVID-19 crisis subsided, usage of inpatient eConsults persisted at a rate well above pre-crisis levels.

Conclusions:

An inpatient eConsults service was successfully implemented, resulting in fewer unnecessary face-to-face consultations and significant reductions in the response times for consults requested on hospitalized patients not requiring an in-person evaluation. Thus, eConsults provided timely, efficient delivery of inpatient consultation services for appropriate problems while minimizing the risk of direct transmission of the COVID-19 virus between healthcare 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 sustainability of service and value.