Electronic Consultation Service Helped VA Hospital Cut Down on Unnecessary Office Visits

the Infectious Disease Advisor take:

BOSTON – The Louis Stokes Cleveland Veterans Affairs Medical Center (VAMC) reduced unexpected infectious disease visits dramatically with the help of an electronic consulting service.

Only 4% of patients who used electronic consultation required an unexpected re-consultation or a physical visit within 30 days. The average time to consult completion was 1.6 days.

“Probably the most common reason for consultation was to interpret culture data--a provider at an outside clinic would send a culture of some type, and wasn’t sure what to do with the result,” said Marion J. Skalweit, MD, PhD, director of the Infectious Diseases Clinic at the Cleveland VAMC at ASM Microbe 2016. “About half of those were cultures of urine in asymptomatic patients.”

Dr. Skalweit presented results from a retrospective study during a poster session Friday at ASM 2016. She said the hospital can relay information to the patient’s primary care provider through the Cleveland VAMC’s electronic medical records system, or speak directly with the patient, rather than scheduling an office visit.

 

The medical center added a physician-led, chart-based, rapid-turnaround, electronic infectious disease consultation service to its pre-existing standard inpatient and outpatient consult services in 2013 as part of a larger VA initiative.

The hospital performed 562 electronic consultations by the end of 2015, 78% of which came from physicians in remote locations. Dr. Skalweit and her colleagues Samuel F. Robinson and Usha Stiefel collected data on patient characteristics, medical conditions, location of requesting health care providers, reasons for consultation, time to consult completion, and efficacy of consultation as measured by the need for a further unexpected infectious disease visit, either electronic or physical, within 30 days.

The data were tabulated and expressed as a percentage of the whole, to construct a descriptive profile of this initial cohort of patients.

Most patients did not have problems that required an office visit (see table). The majority of questions in the “Other” category related to antibiotic use, approval or prophylaxis.

The most common reasons for electronic consultation at Louis Stokes Cleveland Veterans Affairs Medical Center