Objective:

Examine the utility and characteristics of electronic consults utilized in a county hospital neurology clinic.

Background:

The average wait time for an in-person new patient consultation in a neurology clinic at Parkland hospital is five months. The neurology clinic began utilizing electronic consults (e-consults) in March 2019. E-consults provide formalized recommendations regarding pertinent diagnostics or treatment recommendations to requesting outpatient providers.  

Design/Methods:

E-consults to the neurology clinic were reviewed from January 1, 2021 to September 31, 2021. Outpatient providers provide the consult question with relevant information, and neurology physicians (including residents and board certified attendings) review the question and patient’s medical history. Consultants document a diagnosis, possible recommendations, and rationale for recommendations. The consultants provide a synchronous response to the appropriateness of the consult: whether any unnecessary workup was identified, a clinic visit was avoided, and total time spent completing the e-consult. After the specialist completes the response and survey, referring providers are sent the recommendations. We utilized descriptive statistics for this study.

Results:

528 e-consults were reviewed. The most frequent e-consult referrals were for headache (22%; n=114), stroke/neurovascular diagnoses (21%; n=110) and neuropathy (11%; n=58). 94% of e-consults were answered in 1 day. >90% of e-consults took <15 minutes to complete. The physicians surveyed determined that 84% of e-consults were deemed appropriate questions, and 16% were deemed not appropriate, most commonly due to high complexity.  

Conclusions:

E-consults provide increased access to care which is vital in health systems that provide care to vulnerable populations. 94% of e-consults were answered in 1 day as opposed to the 5-month average time for an in-person visit. An e-consult takes approximately 15 minutes or less to complete, which improves efficiency and access to care. By combining these different metrics, we generated compelling evidence supporting and expanding the use of e-consults in a neurology residency training clinic.