Impact of Diabetes E-Consults on Outpatient Clinic Workflow

• Published in: Medical decision making 2015-08, Vol.35 (6), p.745-757
• Main Authors: Zoll, Brian, Parikh, Pratik J., Gallimore, Jennie, Harrell, Stephen, Burke, Brian
• Format: Article
• Language: English
• Subjects: Computer Simulation - utilization; Interdisciplinary Communication; Intersectoral Collaboration; Models, Statistical; Outpatient Clinics, Hospital - utilization; Patient Care Team - utilization; Primary Health Care - utilization; Remote Consultation - utilization; United States; United States Department of Veterans Affairs - utilization; Utilization Review - statistics & numerical data; Workflow
• ISSN: 0272-989X; 1552-681X
• DOI: 10.1177/0272989X14556511

Background. An e-consult is an electronic communication system between clinicians, usually a primary care physician (PCP) and a medical or surgical specialist, regarding general or patient-specific, low complexity questions that would not need an in-person consultation. The objectives of this study were to understand and quantify the impact of the e-consult initiative on outpatient clinic workflow and outcomes. Methods. We collected data from 5 different Veterans Affairs (VA) outpatient clinics and interviewed several physicians and staff members. We then developed a simulation model for a primary care team at an outpatient clinic. A detailed experimental study was conducted to determine the effects of factors, such as e-consult demand, view-alert notification arrivals, walk-in patient arrivals, and PCP unavailability, on e-consult cycle time. Results. Statistical tests indicated that 4 factors related to outpatient clinic workflow were significant, and levels within each of the 4 significant factors resulted in statistically different e-consult cycle times. The arrival rate of electronic notifications, along with patient walk-ins, had a considerable effect on cycle time. Splitting the workload of an unavailable PCP among the other PCPs, instead of the current practice of allocating it to a single PCP, increases the system’s ability to handle a much larger e-consult demand. Conclusions. The full potential of e-consults can only be realized if the workflow at the outpatient clinics is designed or modified to support this initiative. This study furthers our understanding of how e-consult systems can be analyzed and alternative workflows tested using statistical and simulation modeling to improve care delivery and outcomes.