Modernizing the Otolaryngology Referral Workflow: The Impact of Electronic Consultation

Abstract

Objectives/Hypothesis: To determine the impact of electronic consultation on the otolaryngology clinic workflow at our high-volume public hospital.Study Design: Retrospective Observational Study. Methods: This is a retrospective observational analysis study. Operational data regarding clinic volume, referral patterns, and scheduling efficiency were assessed over a 9-month period in 2018 prior to implementation of electronic consultation. The same data were collected for the 9-month period immediately following implementation of electronic consultation in 2019.Results: During the pre-implementation (pre-EC) period, 3,243 otolaryngology referrals were made as compared to 4,249 post-implementation (post-EC). 86% of referrals were scheduled for a clinic appointment pre-EC, compared to 61% post-EC (P < .00001) 24.5% of patients were evaluated within 30 days pre-EC compared to 53.6% post-EC (P < .00001). The average time to be seen by an otolaryngology provider declined from 60.8 days pre-EC to 42.8 days post-EC (P = .0029). There was a 50% decline in the percentage of appointments canceled by patients in the post-EC period as compared to pre-EC.Conclusions: In our experience, implementation of electronic consultation significantly reduced both wait times for a clinic appointment and the percentage of no-show or canceled appointments. Electronic consultation may be a valuable tool in improving the efficiency and yield of the modern otolaryngology clinic.

The Use of Electronic Consultations in Outpatient Surgery Clinics: Synthesized Narrative Review

“…A total of 33 studies were included (Figure 3). The characteristics of the studies analyzed are outlined in Table 1, and detailed descriptions of the studies are provided in Multimedia Appendix 2 [11,18,19,27,39,40,43,44,. Most of the included studies were published in the past 5 years (26/33, 79%), and half were from surgical journals (17/33, 52%), mainly from North America (30/33, 91%).…”

“…Most of these studies used data from a single health service network, and only 1 of the studies combined surgical eConsult data from multiple hospital platforms [49]. Of the retrospective studies, 12% (4/33) were pre-versus postimplementation studies [18,27,50,51]. Approximately 3% (1/33) of the studies used feedback from post-eConsult surveys to assess the ability of the specialist to incorporate this feedback into their practice [44].…”

“…In optional-pathway eConsult services, the rate of face-to-face visits following eConsults was 5.4% to 36% [11,18,43,56,57,65]. The rate was higher for single-pathway eConsult services, at 37% to 92.6%, as there is no triage process for low-acuity conditions [44,64,66,67].…”

“…Conversely, single-specialty studies on otolaryngology eConsults have not replicated this low rate of referral avoidance [52], and thus, further studies must be conducted. Reducing avoidable face-to-face visits not only saves patients time and money but is also beneficial to clinicians-Kinberg et al [18] suggested that avoided referrals free up specialists' time for patients who require a more urgent review. They found that the mean wait time for face-to-face specialist visits decreased from 60.8 to 42.8 days following eConsult implementation.…”

“…The information returned from the specialist via the eConsults provides the PCP with assistance with diagnosis, imaging interpretation, and advice on management [17]. The web-based communication platform may be a health service-specific program, or a shared electronic medical record (EMR), where the correspondence is recorded [18,19]. Outcomes include scheduling a face-to-face appointment if required or giving management advice virtually.…”