Department of Pathology (Stendahl, Siddon), Yale School of Medicine, New Haven, Connecticut.
Department of Laboratory Medicine (Stendahl, Siddon, Peaper, Hauser, Campbell, Tormey), Yale School of Medicine, New Haven, Connecticut.
Arch Pathol Lab Med. 2021 Jan 1;145(1):75-81. doi: 10.5858/arpa.2019-0267-OA.
CONTEXT.—: A novel electronic consult (e-consult) system for a pathology and laboratory medicine service (PLMS) was implemented in 2015 at a high-complexity Veterans Administration health care facility. Consults were previously made through direct provider communication without documentation in the medical record.
OBJECTIVE.—: To evaluate the utilization trends of the laboratory e-consult system at the Department of Veterans Affairs Connecticut facility during the first 2 years since inception.
DESIGN.—: E-consultation involves pathology and laboratory medicine resident review followed by attending pathologist review and cosignature. E-consults to the pathology and laboratory medicine service from 2015 to 2017 were reviewed to record type of consult, requesting department, patient location, and turnaround time.
RESULTS.—: The pathology and laboratory medicine service received 351 e-consults from 2015 to 2017. The volume varied by subsection: hematology and coagulation (215 of 351; 61%), chemistry (109 of 351; 31%), blood bank (19 of 351; 6%), and microbiology/virology (8 of 351; 2%). Hematology and coagulation consults were entirely for peripheral blood smear review (215 of 215; 100%). Chemistry consults were placed for toxicology/drugs of abuse (81 of 109; 74%), test utilization (17 of 109; 16%), or nontoxicology (11 of 109; 10%). Three services placed the majority of consults: primary care (279 of 351; 80%), hematology/oncology (39 of 351; 11%), and psychiatry (27 of 351; 8%). The median turnaround time for completion of e-consults was 1.2 days. Since e-consult implementation, the mean number of consults increased from 8.6/mo in 2015 to 18.1/mo in 2017, peaking in the last quarter of analysis in 2017 with a mean of 25.3 consults/mo.
CONCLUSIONS.—: This novel e-consult system improved accessibility to and documentation of answers to laboratory questions and increased the visibility of the pathology and laboratory medicine service. Future goals include development of outcomes-based measures to better assess the clinical impact of e-consults.
2015 年，一家高复杂度退伍军人事务医疗保健机构实施了一种用于病理和实验室医学服务（PLMS）的新型电子咨询（e-consult）系统。在此之前，咨询是通过直接提供者沟通进行的，医疗记录中没有文件记录。
评估自 2015 年成立以来，退伍军人事务康涅狄格州机构的实验室电子咨询系统在头 2 年的使用趋势。
电子咨询涉及病理和实验室医学住院医师审查，随后由主治病理学家审查并共同签名。对 2015 年至 2017 年期间向病理和实验室医学服务提出的电子咨询进行了审查，以记录咨询类型、请求部门、患者位置和周转时间。
病理和实验室医学服务在 2015 年至 2017 年期间共收到 351 份电子咨询。按小节划分，数量有所不同：血液学和凝血（215/351；61%）、化学（109/351；31%）、血库（19/351；6%）和微生物学/病毒学（8/351；2%）。血液学和凝血咨询完全用于外周血涂片审查（215/215；100%）。化学咨询用于毒理学/药物滥用（81/109；74%）、测试利用（17/109；16%）或非毒理学（11/109；10%）。三个服务部门提出了大部分咨询意见：初级保健（279/351；80%）、血液学/肿瘤学（39/351；11%）和精神病学（27/351；8%）。电子咨询完成的中位数周转时间为 1.2 天。自电子咨询实施以来，咨询量从 2015 年的每月 8.6 次增加到 2017 年的每月 18.1 次，在分析的最后一个季度（2017 年）达到峰值，平均每月有 25.3 次咨询。
这种新型电子咨询系统提高了对实验室问题答案的可及性和文件记录，并提高了病理和实验室医学服务的可见度。未来的目标包括制定基于结果的措施，以更好地评估电子咨询的临床影响。
