Inpatient Electronic Consultations (E-consults) in Allergy/Immunology

Abstract

Background: Electronic consultations (e-consults) are asynchronous clinician-to-clinician exchanges within the electronic health record (EHR).

Objective: We sought to demonstrate the utility of e-consults in allergy/immunology (A/I) inpatient consultations.

Methods: Inpatients ≥18 years of age for whom an A/I consultation was requested were eligible for an e-consult. An e-consult was completed if considered appropriate by the A/I physician with recommendations made in the EHR. In-person consultation was performed for inpatients if deemed necessary. Likert scale satisfaction data were collected from requesting providers after the e-consultation. Cost was calculated using time-based billing codes plus the cost of penicillin allergy evaluation, if appropriate.

Results: Of the 109 inpatient consults, 78 (71.6%) were completed through an e-consult and 31 (28.4%) were completed by an in-person consult. The most common indication for an inpatient consult was evaluation of penicillin allergy in 73 (67%) patients. The most common reason to complete an in-person consult was the need to complete penicillin skin testing in 17 of the 31 (55%) patients. E-consults were completed in less time than in-person consults (15 minutes, interquartile range [IQR]: 10-15 vs 60 minutes, IQR: 45-60, P < .001) and had a shorter turnaround time (1 hour, IQR: 0.5-2 vs 7 hours, IQR: 3-19, P < .001). Management recommendations were followed at a similar rate regardless of type of consult (88% of e-consults vs 96% of in-person consults, P = .162). A total of 97% of requesting providers reported an "excellent" or "good" impression of e-consults. E-consults were less costly than in-person consults.

Conclusions: E-consults have utility in providing inpatient A/I consultation and may have advantages over in-person evaluation, while adequately maintaining provider satisfaction.

Keywords: Allergy/immunology; E-consult; Electronic consultation; Inpatient; Penicillin allergy.