M7 Impact and evaluation of electronic clinician-to-clinician advice service (e- consultation)

Abstract

BackgroundElectronic clinician-to-clinician advice service (E- consultation) is a telehealth modality1 that enables the primary care clinicians to seek advice from specialists through a shared electronic system (Systm one). This is a mode of non-face to face consult and for less complex cases this service potentially reduces unnecessary clinic referrals and provides an efficient specialist input thus improving patient care.2,3 This was first piloted in NHS Yorkshire and Humber in 2012. In agreement with clinical commissioning group (CCG), our trust implemented this in March 2015 and we have evaluated the impact of this service.MethodWe retrospectively reviewed all patients who had an e-consultation (March 2015 – January 2017). Patient demographics and clinical information were retrieved from systm one. The referral to clinician response time, content of the referrals, the outcome of the e-consultations and the cost analysis based on nationally agreed tariff (Respiratory treatment code- 340, £23 per e-consultation) was evaluated.Results324 patients (63+/-16 years, males- 54%) had an e-consultation. Clinicians completed these referrals in 3 days (IQR=1–7 days, range=0–32 days). The content of the e-consultations were classified under five domains- investigations (n=91, 28%), radiology (n=114, 35%), medications (n=32, 10%), miscellaneous (n=6, 2%) and mixed (n=81, 25%). 63% (n=204) of the referrals were initiated by the general practitioner, 25% (n=81)- practice nurses and 12% (n=39)- trainees. 32% (n=105) of the e-consultations were recommended for a formal clinic review. Since implementation, this service has generated over £7000 to the trust.Discussion and conclusionsThis novel service is available for routine, non-urgent specialist advice only and is easy to access. This new approach does not seem to have a significant burden to our other ongoing clinical activities. It provides an opportunity to screen potential formal referrals and identifies the need for specific investigations prior to treatment. However a third of all e-consultations were recommended for a clinic review. Further discussion with the CCG is ongoing to improve the service by having a criteria led referrals and to promote training and awareness of this service.References. L.A. Care Health Plan2012.. Harno et al. Journal of Telemed Telecare6(5):320–9.. Kim et al. Journal of General Internal Medicine2009;24(5):614–619.