%0 Journal Article
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e55623
%T Implementation of Inpatient Electronic Consultations During the COVID-19 Crisis and Its Sustainability Beyond the Pandemic: Quality Improvement Study
%A Aledia,Anna S
%A Dangodara,Amish A
%A Amin,Aanya A
%A Amin,Alpesh N
%+ Department of Medicine & Hospital Medicine, University of California, Irvine, 333 City Boulevard West, Suite 500, Orange, CA, 92868, United States, 1 714 456 3785, anamin@uci.edu
%K COVID-19
%K electronic consultation
%K eConsult
%K e-consult
%K inpatient
%K consultations
%K pandemic
%K infectious
%K novel coronavirus
%K coronavirus
%K patients
%K patient
%K staff
%K health care
%K health care providers
%K tool
%K tools
%K effectiveness
%D 2024
%7 16.5.2024
%9 Original Paper
%J J Med Internet Res
%G English
%X Background: Limiting in-person contact was a key strategy for controlling the spread of the highly infectious novel coronavirus (COVID-19). To protect patients and staff from the risk of infection while providing continued access to necessary health care services, we implemented a new electronic consultation (e-consult) service that allowed referring providers to receive subspecialty consultations for patients who are hospitalized and do not require in-person evaluation by the specialist. Objective: We aimed to assess the impact of implementing e-consults in the inpatient setting to reduce avoidable face-to-face referrals during the COVID-19 pandemic. Methods: This quality improvement study evaluated all inpatient e-consults ordered from July 2020 to December 2022 at the University of California Irvine Medical Center. The impact of e-consults was assessed by evaluating use (eg, number of e-consults ordered), e-consult response times, and outcome of the e-consult requests (eg, resolved electronically or converted to the in-person evaluation of patient). Results: There were 1543 inpatient e-consults ordered across 11 participating specialties. A total of 53.5% (n=826) of requests were addressed electronically, without the need for a formal in-person evaluation of the patient. The median time between ordering an e-consult and a specialist documenting recommendations in an e-consult note was 3.7 (IQR 1.3-8.2) hours across all specialties, contrasted with 7.3 (IQR 3.6-22.0) hours when converted to an in-person consult (P<.001). The monthly volume of e-consult requests increased, coinciding with surges of COVID-19 cases in California. After the peaks of the COVID-19 crisis subsided, the use of inpatient e-consults persisted at a rate well above the precrisis levels. Conclusions: An inpatient e-consult service was successfully implemented, resulting in fewer unnecessary face-to-face consultations and significant reductions in the response times for consults requested on patients who are hospitalized and do not require an in-person evaluation. Thus, e-consults provided timely, efficient delivery of inpatient consultation services for appropriate problems while minimizing the risk of direct transmission of the COVID-19 virus between health care providers and patients. The service also demonstrated its value as a tool for effective inpatient care coordination beyond the peaks of the pandemic leading to the sustainability of service and value. 
%M 38754103
%R 10.2196/55623
%U https://www.jmir.org/2024/1/e55623
%U https://doi.org/10.2196/55623
%U http://www.ncbi.nlm.nih.gov/pubmed/38754103