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Aledia AS, Dangodara AA, Amin AA, Amin AN. Implementation of Inpatient Electronic Consultations During the COVID-19 Crisis and Its Sustainability Beyond the Pandemic: Quality Improvement Study. J Med Internet Res 2024; 26:e55623. [PMID: 38754103 PMCID: PMC11140270 DOI: 10.2196/55623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 05/18/2024] Open
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.
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Affiliation(s)
- Anna S Aledia
- Department of Medicine & Hospital Medicine, University of California, Irvine, Orange, CA, United States
| | - Amish A Dangodara
- Department of Medicine & Hospital Medicine, University of California, Irvine, Orange, CA, United States
| | - Aanya A Amin
- Department of Medicine & Hospital Medicine, University of California, Irvine, Orange, CA, United States
| | - Alpesh N Amin
- Department of Medicine & Hospital Medicine, University of California, Irvine, Orange, CA, United States
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Conrad ZA, Salazar AP, Akers A, Jodlowski TZ, Wang L, Drechsler H, Storey DF, Arasaratnam RJ. Impact of an Educational and Laboratory Stewardship Intervention on Inpatient COVID-19 Therapeutics at a Veterans Affairs Medical Center. Fed Pract 2023; 40:146-151. [PMID: 37727509 PMCID: PMC10506492 DOI: 10.12788/fp.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Background Accurate and timely prescriptions of COVID-19 therapeutics, laboratory testing, and antimicrobial stewardship have been a challenge throughout the pandemic as new evidence emerges. While universal consultation with infectious disease specialists on patients admitted with COVID-19 is desirable, it is not always feasible due to limited resources. Observations In this single-center study, we implemented a combined educational and laboratory stewardship intervention geared toward hospitalist practitioners resulting in improved accuracy of remdesivir and dexamethasone prescriptions, reduced laboratory use of blood cultures, interleukin 6 assay, and Legionella sputum cultures, and a decrease in antibiotic use for patients with mild-to-moderate oxygen requirements over 6 months. These improvements were seen in tandem with decreased reliance on infectious disease consultation. Conclusions These efforts support proof of the principle of combined educational and laboratory stewardship interventions to improve the care of COVID-19 patients, especially where infectious disease consultation may not be available or is accessed remotely.
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Affiliation(s)
- Zane A Conrad
- University of Texas Southwestern Medical Center, Dallas
| | | | | | | | - Li Wang
- University of Texas Southwestern Medical Center, Dallas
| | - Henning Drechsler
- University of Texas Southwestern Medical Center, Dallas
- Dallas Veterans Affairs Medical Center, Texas
| | - Donald F Storey
- University of Texas Southwestern Medical Center, Dallas
- Dallas Veterans Affairs Medical Center, Texas
| | - Reuben J Arasaratnam
- University of Texas Southwestern Medical Center, Dallas
- Dallas Veterans Affairs Medical Center, Texas
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Medford RJ, Granger M, Pickering M, Lehmann CU, Mayorga C, King H. Implementation of Outpatient Infectious Diseases E-Consults at a Safety Net Healthcare System. Open Forum Infect Dis 2022; 9:ofac341. [PMID: 35903155 PMCID: PMC9315945 DOI: 10.1093/ofid/ofac341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Indexed: 01/24/2023] Open
Abstract
Background Safety net healthcare systems have high patient volumes and significant demands for specialty care including infectious diseases (ID) consultations. Electronic ID consults (E-consults) can lessen this burden by providing an alternative to face-to-face ID referrals and decreasing financial, time, and travel constraints on patients. This system could increase access to ID care for patients in limited-resource settings. Methods We described characteristics of all outpatient ID E-consults at Parkland Health in Dallas, Texas, from March 2018 to February 2021. We used modeling to determine which characteristics influenced conversion of E-consults to clinic visits and integrated these data into a predictive model for face-to-face conversion. Results For 725 E-consults, common E-consult topics included 118 (16%) latent tuberculosis, 116 (16%) syphilis, and 76 (10%) gastrointestinal infections. Nearly two-thirds of E-consults (456 [63%]) were requested by primary care providers. The majority (78%) were resolved without a face-to-face ID visit. Osteomyelitis, nontuberculous mycobacterial, and gastrointestinal questions frequently required face-to-face visits at rates of 65%, 49%, and 32%, respectively. Our logistic regression model predicted the need for a face-to-face visit with 80% accuracy and an area under the receiver operating characteristic curve of 0.72. Conclusions An outpatient ID E-consult program at a safety net healthcare system was an effective tool to provide timely input on common ID topics. E-consults were requested by a range of providers, and most were completed without a face-to-face visit. Predictive modeling identified important characteristics of E-consults and predicted conversion to face-to-face visits with reasonable accuracy.
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Affiliation(s)
- Richard J Medford
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA,Division of Infectious Diseases, Parkland Health and Hospital System, Dallas, Texas, USA,Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madison Granger
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Madison Pickering
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA,Division of Physical Sciences, Department of Computer Science, University of Chicago, Chicago, Illinois, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christian Mayorga
- Division of Digestive and Liver Diseases, Parkland Health and Hospital System, Dallas, Texas, USA,Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Helen King
- Correspondence: Helen King, MD, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9113, USA ()
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