Ulloa Jesus G, Russell Marika D, Chen Alice Hm, Tuot Delphine S
Veterans Affairs/Robert Wood Johnson Foundation, Clinical Scholars Program, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Department of Otolaryngology, University of California, San Francisco, CA, 94143, USA.
BMC Health Serv Res. 2017 Jun 23;17(1):433. doi: 10.1186/s12913-017-2375-0.
Electronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case).
Retrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014. Electronic consultation requests were reviewed for the presence/absence of consult domains: symptom acuity/severity, diagnostic evaluation, concurrent medical conditions, and attempted diagnosis. Logic regression was used to examine the association between completeness of consult requests and scheduling an ambulatory clinic visit. Surgical yield was also calculated, as was the percentage of patients requiring unanticipated healthcare visits.
In 2014, 1743 electronic consultations were submitted to general surgery. Among the 150 abstracted, the presence of consult domains ranged from 49% to 99%. Consult completeness was not associated with greater likelihood of scheduling an ambulatory visit. Seventy-six percent of consult requests (114/150) were scheduled for a clinic appointment and surgical yield was 46%; without an eConsult system, surgical yield would have been 35% (p=0.07). Among patients not scheduled for a clinic visit (n=36), 4 had related unanticipated emergency department visits.
Econsult systems can be used to safely optimize the surgical yield of a safety-net general surgery service.
电子会诊（eConsult）系统增强了获得专科专业知识的机会，并加强了初级保健和专科保健提供者之间的护理协调，同时保持了初级保健提供者（PCP）、专科医生和患者的高满意度。关于它们对专科护理效率的影响，尤其是手术产出率（门诊就诊导致安排手术病例的百分比），人们了解甚少。
对2014年从初级保健提供者转至安全网普通外科诊所的150例电子会诊进行随机选择的回顾性队列研究，涉及三种最常见的普通外科手术（疝修补术、胆囊切除术、肛肠手术）。审查电子会诊请求中是否存在会诊领域：症状严重程度、诊断评估、并发疾病以及尝试性诊断。使用逻辑回归分析来检查会诊请求的完整性与安排门诊就诊之间的关联。还计算了手术产出率以及需要意外医疗就诊的患者百分比。
2014年，共向普通外科提交了1743例电子会诊。在抽取的150例中，会诊领域的存在范围为49%至99%。会诊完整性与安排门诊就诊的可能性增加无关。76%的会诊请求（114/150）被安排了门诊预约，手术产出率为46%；如果没有电子会诊系统，手术产出率将为35%（p=0.07）。在未安排门诊就诊的患者（n=36）中，有4人因相关情况意外前往急诊科就诊。
电子会诊系统可用于安全地优化安全网普通外科服务的手术产出率。
