Med Decis Making - Impact of Diabetes E-Consults on Outpatient Clinic Workflow.

Tópicos

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Resumo

CKGROUND: An e-consult is an electronic communication system between clinicians, usually a primary care physician (PCP) and a medical or surgical specialist, regarding general or patient-specific, low complexity questions that would not need an in-person consultation. The objectives of this study were to understand and quantify the impact of the e-consult initiative on outpatient clinic workflow and outcomes.METHODS: We collected data from 5 different Veterans Affairs (VA) outpatient clinics and interviewed several physicians and staff members. We then developed a simulation model for a primary care team at an outpatient clinic. A detailed experimental study was conducted to determine the effects of factors, such as e-consult demand, view-alert notification arrivals, walk-in patient arrivals, and PCP unavailability, on e-consult cycle time.RESULTS: Statistical tests indicated that 4 factors related to outpatient clinic workflow were significant, and levels within each of the 4 significant factors resulted in statistically different e-consult cycle times. The arrival rate of electronic notifications, along with patient walk-ins, had a considerable effect on cycle time. Splitting the workload of an unavailable PCP among the other PCPs, instead of the current practice of allocating it to a single PCP, increases the system's ability to handle a much larger e-consult demand.CONCLUSIONS: The full potential of e-consults can only be realized if the workflow at the outpatient clinics is designed or modified to support this initiative. This study furthers our understanding of how e-consult systems can be analyzed and alternative workflows tested using statistical and simulation modeling to improve care delivery and outcomes.

Resumo Limpo

ckground econsult electron communic system clinician usual primari care physician pcp medic surgic specialist regard general patientspecif low complex question need inperson consult object studi understand quantifi impact econsult initi outpati clinic workflow outcomesmethod collect data differ veteran affair va outpati clinic interview sever physician staff member develop simul model primari care team outpati clinic detail experiment studi conduct determin effect factor econsult demand viewalert notif arriv walkin patient arriv pcp unavail econsult cycl timeresult statist test indic factor relat outpati clinic workflow signific level within signific factor result statist differ econsult cycl time arriv rate electron notif along patient walkin consider effect cycl time split workload unavail pcp among pcps instead current practic alloc singl pcp increas system abil handl much larger econsult demandconclus full potenti econsult can realiz workflow outpati clinic design modifi support initi studi further understand econsult system can analyz altern workflow test use statist simul model improv care deliveri outcom

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