High rates of appropriate e-consults seen across specialties

The rates of appropriate electronic consultations (e-consults) are high across specialties, according to a study published online April 14 in the Annals of Internal Medicine.

Salman Ahmed, M.D., M.P.H., from Brigham and Women's Hospital in Boston, and colleagues conducted a retrospective cohort study to examine the appropriateness of e-consult inquiries among patients with e-consult requests to hematology, infectious disease, dermatology, rheumatology, and psychiatry. Appropriateness was assessed by review of medical records and was defined as meeting four criteria; utility was assessed by rate of avoided visits (AVs).

Data were included for 6,512 eligible e-consults made by 1,096 referring providers to 121 specialist consultants. The researchers found that inquiries were classified as diagnostic, therapeutic, for provider education, and at patient request. Most of the consultations were answered within one day, ranging across specialties from 73.1 percent for psychiatry to 87.8 percent for infectious diseases. A total of 70.2 percent of all e-consults met all four appropriateness criteria; among specialties, there was variation in the frequency of unmet criteria. The appropriateness of 94 percent of e-consults was agreed upon by raters (κ = 0.57), indicating moderate agreement. Across the five specialties, the overall rate of AVs was 81.2 percent, with the highest and lowest rates seen in psychiatry (92.6 percent) and dermatology (61.9 percent), respectively.

"Focusing on appropriateness criteria in e-consults will refine their use and is an essential element in improving AV rates across specialties," the authors write.

One author disclosed ties to Bayer.