Alternative to curbside consults: The eConsult-patient safety first!

January 4, 2019

TOPICS: Primary Care
eConsults-as-alternative-to-curbside-consults

The practice of curbside consult is routine for many practicing physicians. However, a brief review of potential shortcomings of this practice is essential to ensure solutions are in place to enable the best possible patient care. An eConsult is an evolved, official form of the curbside consult that addresses many inherent issues within these informal exchanges, including missing or incomplete patient information, the lack of access to physical exam findings, and other relevant data/or lab results.

The literature review demonstrates that approximately one-third of the information needs of family physicians or PCPs are fulfilled using informal (or curbside) consults.1,2 Curbside consult refers to a process by which a provider—informally and without documentation—receives information from another provider to assist in managing a patient. There are several criteria for a consultation to be considered a “curbside consultation”, whic,”,”e explored in more detail within this article.

PCPs self-report obtaining an average of 3.2 curbside consults per week, while subspecialists report receiving approximately 3.6 per week. One feature of managed care has been to better work the triage of specialist referrals to reduce the cost of care for healthcare payers. As a result, many PCPs have had to assume greater responsibility for maintaining conditions previously considered within the realm of the subspecialist. Thus, it is likely that PCPs will increase the use of curbside consultations to obtain clinical advice and information in an attempt to maintain quality care while limiting the number of formal referrals.2,3

 

​With the practice of curbside consult posing liability, eConsults enable providers to receive timely, documented input reliably. The eConsult workflow is much easier, and we, as providers, aren’t waiting by the phone or called out of a room when a specialist calls back.

Dr. Sue Park, Vista Community Clinics (VCC)

The downside to the unofficial curbside consult

As a method of care planning support, include the following considerations:

Inaccurate, incomplete, or biased clinical information can result from an informal review.

Unlike a formal consultation, a curbside consult doesn’t involve a detailed history, physical examination, or review of laboratory and radiographic studies. The time pressure of an immediate response during a curbside has been identified as a source of incomplete and erroneous recommendations.

The process is inefficient and cumbersome

Obtaining curbside consults interrupts workflows and disrupts standard processes. Delays in patient care result from needing to contact a specialist, tracking down within the facility, awaiting availability, follow-up messages, etc.

Lack of documentation is inherent

Without proper documentation, there are often gaps in the patient record regarding why specific treatment pathways were chosen. Additionally, lack of documentation inhibits the provision of optimal treatment guidance, as entire medical history is not reliably communicated, leaving both provider and specialist potentially liable.

Access to the network is limited and often unreliable

Providers are limited to specialists within their clinic or closed network. These specialists may not be available consistently, and time is often limited.

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eConsults provide a way for providers to engage in secure, detailed, and documented collaboration

This approach has numerous beneficial aspects, such as the following:

eConsults provide reliable access to a broad network of specialists

eConsult platforms allow providers access to hundreds of specialists within their existing referral workflow. Responses are timely and are received through standardized methods of communication. Providers can enter multiple eConsults for a patient, with consistent follow-up

Documentation of patient history and specialist responses promotes a thorough assessment of the most complex cases

Whereas traditional curbsides are limited by lack of information, history, and detail, specialists responding to eConsults have access to all relevant clinical information (including lab results, images, and medical history). Since eConsults occur asynchronously, specialists are not constrained by time and can thoroughly assess, research, respond, and answer questions from the requesting provider. All eConsults are signed and dated by the consulting specialist and become an official part of the patient record. Chronic conditions and case follow-up can be managed by utilizing eConsults for the same patient over an extended period as eConsult history is always accessible.

The eConsult process is embedded into the referral processing workflow

An easy-to-use, standardized process for providers increases efficiency. Providers no longer need to wait on the availability of specialists—with AristaMD’s platform, the response is guaranteed within 24 hours, the majority being responded to within the same. day

Providers have an increased opportunity to grow their knowledge base

The detail and documentation accompanying eConsults allow providers the opportunity to expand their knowledge base over time. eConsults with identified specialists provide expanded access to a specialized team that can be tapped for recommendations on treatment planning or to confirm a suspected diagnosis. Providers can reference a database of their eConsults for guidance on future cases.

 

Collaboration between providers is critical, and eConsults are an effective and scalable alternative to traditional curbside consult practices. Documented, asynchronous eConsults provide enhanced documentation and traceability, ensure detailed specialist feedback, and maximize efficient and appropriate use of provider resources. Lastly, requesting providers are given rapid feedback th; they to deliver the highest quality care to their patients.

References:

  • Gruppen LD, Wolf FM, Van Voorhees CV, Stross JK. Information-seeking strategies and differences among primary care physicians. Mobius 1987; 7:18-26.
  • Ely JW, Burch RJ, Vinson DC. The information needs of family physicians: case-specific clinical questions. J Fam Pract 1992; 25:265-9.
  • Bergus, GR, et al. Use of an E-mail Curbside Consultative Service by Family physicians.