O'Dwyer Brynn, Macaulay Karen, Murray Jessica, Jaana Mirou
Telfer School of Management, University of Ottawa, Ottawa, Canada.
Children's Hospital of Eastern Ontario, Ottawa, Canada.
Telemed J E Health. 2024 May;30(5):1306-1316. doi: 10.1089/tmj.2023.0444. Epub 2023 Dec 15.
Background:The COVID-19 pandemic has exacerbated wait times for pediatric specialty care. Transformative technologies such as electronic referral (eReferral-automation of patient information) and electronic consultations (eConsult-asynchronous request for specialized advice by primary care providers) have the potential to increase timely access to specialist care. The objective of this study was to present an overview of the current state and characteristics of referrals directed to a pediatric ambulatory medical surgery center, with an emphasis on the innovative use of an eConsult system and to indicate key considerations for system improvement.
Methods:This cross-sectional study was conducted at a specialized pediatric acute care hospital in Ottawa, Ontario. Secondary data were obtained over a 2-year period during the COVID-19 pandemic (2019-2022). To gain insights and identify areas of improvement related to the factors pertaining to referrals and eConsults at the process and system levels, quality improvement (QI) methodologies were employed. Descriptive statistics provide a summary of the trends and characteristics of referrals and the utilization of eConsult.
Results:Among the 113,790 referrals received, 31,430 were denied. Most common reasons for referral denial were other/null (e.g., unspecified) (29.3%), inappropriate referrals (12.6%), and duplicate referrals (12.4%). Four clinics (e.g., endocrinology, cardiology, neurology, and neurosurgery) reported a total of 277 eConsults, with endocrinology accounting for 95.0% of all eConsults. QI findings revealed the need for standardized workflows among specialties and ensuring that eConsult options are accessible and integrated within the electronic medical record (EMR).
Conclusions: Refining the pediatric referral management process and optimizing eConsult through existing clinical systems have the potential to improve the timeliness and quality of specialty care. The results inform future research initiatives targeting improved access to pediatric specialty care and serve as a benchmark for hospitals utilizing EMRs and eConsult.
新冠疫情加剧了儿童专科护理的等待时间。诸如电子转诊（电子转诊——患者信息自动化）和电子会诊（电子会诊——初级保健提供者异步请求专科建议）等变革性技术有可能增加及时获得专科护理的机会。本研究的目的是概述转诊至儿科门诊医疗手术中心的当前状态和特点，重点是电子会诊系统的创新应用，并指出系统改进的关键考虑因素。
本横断面研究在安大略省渥太华的一家专门的儿科急症医院进行。在新冠疫情期间（2019 - 2022年）的两年时间里获取了二手数据。为了深入了解并确定与转诊和电子会诊相关的过程和系统层面因素的改进领域，采用了质量改进（QI）方法。描述性统计提供了转诊趋势和特点以及电子会诊使用情况的总结。
在收到的113,790份转诊中，31,430份被拒绝。转诊被拒绝的最常见原因是其他/无（例如未指定）（29.3%）、不适当转诊（12.6%）和重复转诊（12.4%）。四个科室（例如内分泌科、心脏病科、神经科和神经外科）共报告了277次电子会诊，其中内分泌科占所有电子会诊的95.0%。质量改进结果表明各专科之间需要标准化工作流程，并确保电子会诊选项在电子病历（EMR）中可访问且集成。
完善儿科转诊管理流程并通过现有临床系统优化电子会诊，有可能提高专科护理的及时性和质量。这些结果为未来旨在改善获得儿科专科护理机会的研究倡议提供了信息，并为使用电子病历和电子会诊的医院提供了一个基准。
