Neelam A Phadke1, Anna R Wolfson2, Christian Mancini3, Xiaoqing Fu4, Susan A Goldstein5, Jacqueline Ngo5, Jason H Wasfy6, Aidan Long2, Aleena Banerji2, Kimberly G Blumenthal7. 1. Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: nphadke@partners.org. 2. Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. 3. Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Mass. 4. Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass. 5. Performance Analysis and Improvement Unit, Massachusetts General Hospital, Boston, Mass; Massachusetts General Physicians Organization, Boston, Mass. 6. Harvard Medical School, Boston, Mass; Massachusetts General Physicians Organization, Boston, Mass; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Mass. 7. Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass.
Abstract
BACKGROUND: Allergic condition management more often requires allergist guidance than allergy testing; necessary testing may be unavailable at initial drug allergy consultations. Electronic consultations (e-consults) provide expedited, problem-focused, potentially cost-saving care in other medical specialties, but have not yet been studied in Allergy/Immunology. OBJECTIVE: To describe e-consult use at an academic allergy/immunology practice. METHODS: E-consult data (August 10, 2016 through July 31, 2018) and in-person consult data (August 1, 2014 through July 31, 2018) were reviewed to determine consult volume, outcomes, indications, and timing. Referral reasons and wait times were compared with chi-square tests. RESULTS: E-consults grew from 1% to 10% of all new consults, with concurrent growth in in-person consults. Of 306 completed e-consults, 41 (13.4%) made diagnostic, therapeutic, or alternative referral recommendations, with 30 (73%) recommendations followed; 183 (59.8%) patients required an in-person Allergy/Immunology consult, and only 5 (<2%) patients saw an allergist without an e-consult recommendation to do so. E-consults were used more often than in-person consults for adverse drug reactions (66% vs 9%; P < .001), especially penicillin allergy (132, 61% of all e-consults) and immunodeficiency (15% vs 2%; P < .001). Allergists completed e-consults in a median of 11 minutes, with a median turnaround time of 22 hours. E-consult implementation was associated with a decreased median in-person consult wait time (1.5 fewer calendar days; P < .05). CONCLUSIONS: E-consults were increasingly used, particularly for historical adverse drug reactions and immunodeficiency. Implementation of an e-consult program resulted in decreased in-person wait times despite an increase in overall consult volume, supporting this model's ability to provide expedited, problem-focused care.
BACKGROUND: Allergic condition management more often requires allergist guidance than allergy testing; necessary testing may be unavailable at initial drug allergy consultations. Electronic consultations (e-consults) provide expedited, problem-focused, potentially cost-saving care in other medical specialties, but have not yet been studied in Allergy/Immunology. OBJECTIVE: To describe e-consult use at an academic allergy/immunology practice. METHODS: E-consult data (August 10, 2016 through July 31, 2018) and in-person consult data (August 1, 2014 through July 31, 2018) were reviewed to determine consult volume, outcomes, indications, and timing. Referral reasons and wait times were compared with chi-square tests. RESULTS: E-consults grew from 1% to 10% of all new consults, with concurrent growth in in-person consults. Of 306 completed e-consults, 41 (13.4%) made diagnostic, therapeutic, or alternative referral recommendations, with 30 (73%) recommendations followed; 183 (59.8%) patients required an in-personAllergy/Immunology consult, and only 5 (<2%) patients saw an allergist without an e-consult recommendation to do so. E-consults were used more often than in-person consults for adverse drug reactions (66% vs 9%; P < .001), especially penicillinallergy (132, 61% of all e-consults) and immunodeficiency (15% vs 2%; P < .001). Allergists completed e-consults in a median of 11 minutes, with a median turnaround time of 22 hours. E-consult implementation was associated with a decreased median in-person consult wait time (1.5 fewer calendar days; P < .05). CONCLUSIONS: E-consults were increasingly used, particularly for historical adverse drug reactions and immunodeficiency. Implementation of an e-consult program resulted in decreased in-person wait times despite an increase in overall consult volume, supporting this model's ability to provide expedited, problem-focused care.
Authors: Mary L Staicu; David Vyles; Erica S Shenoy; Cosby A Stone; Taylor Banks; Kristin S Alvarez; Kimberly G Blumenthal Journal: J Allergy Clin Immunol Pract Date: 2020-10
Authors: Neelam A Phadke; Marcela G Del Carmen; Susan A Goldstein; Jacqueline Vagle; Michael K Hidrue; Eirian Siegal Botti; Jason H Wasfy Journal: J Gen Intern Med Date: 2020-05-18 Impact factor: 5.128
Authors: Anna R Wolfson; Christian M Mancini; Aleena Banerji; Xiaoqing Fu; Allison S Bryant; Neelam A Phadke; Erica S Shenoy; Weaam Arman; Yuqing Zhang; Kimberly G Blumenthal Journal: J Allergy Clin Immunol Pract Date: 2020-11-16