Endocrine econsults improve access to care for the underserved

Abstract

The endocrinology eConsult service at Mount Sinai Hospital, in New York City, was conceived to simplify and accelerate access to the expertise of endocrinologists. Here we detail how we designed our workflow according to input from primary care providers (PCPs). Additionally, we describe the impact of the pilot phase of our endocrinology eConsult service. In this pilot phase, providers in a Medicaid clinic and those making visits to homebound patients placed eConsult orders within the hospital's EMR using one of 18 original, disease-specific templates and one generic template. The eConsultant sent evidence-based recommendations in a response template, which included a rationale with references. As part of an ongoing quality improvement project, PCPs were asked to complete a two question closeout survey. Seventy percent of PCPs indicated that they got good advice for a new or additional course of action, and 25% answered that they were able to confirm a course of action that they already had in mind. Referral was originally contemplated, but avoided as a result of the eConsult according to 62% of respondents, exceeding rates reported at other academic institutions. Our unique emphasis on providing a detailed rationale for recommendations may have contributed to these outcomes. With a majority of respondents indicating that a formal consultation was averted, an expanded endocrine eConsult service could reduce a significant volume of unnecessary endocrine referrals, expedite more urgent visits, and reduce costs. This outcome is especially significant in light of a nationwide shortage of endocrinologists.