Scientific Publications Database

Article Title: The impact of electronic consultation on a Canadian tertiary care pediatric specialty referral system: A prospective single-center observational study
Authors: Lai, Lillian; Liddy, Clare; Keely, Erin; Afkham, Amir; Kurzawa, Julia; Abdeen, Nishard; Audcent, Tobey; Bromwich, Matthew; Brophy, Jason; Carsen, Sasha; Fournier, Annick; Fraser-Roberts, Leigh; Gandy, Hazen; Hui, Charles; Johnston, Donna; Keely, Kathryn; Kontio, Ken; Lamontagne, Christine; Major, Nathalie; O'Connor, Michael; Radhakrishnan, Dhenuka; Reisman, Joe; Robb, Marjorie; Samson, Lindy; Sell, Erick; Splinter, William; van Stralen, Judy; Venkateswaran, Sunita; Murto, Kimmo
Journal: PLOS ONE Volume 13 Issue 1
Date of Publication:2018
Abstract:
Background Champlain BASE (TM) (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.ObjectiveTo 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.DesignProspective observational cohort study.SettingSingle 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 measuresSpecialty service utilization and access, impact on PCP course-of-action and referral-patterns and survey-based provider satisfaction data were collected.Results1064 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.Conclusionsand 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.