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Impact of Diabetes E-Consults on Outpatient Clinic Workflow

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  • Brian Zoll
  • Pratik J. Parikh
  • Jennie Gallimore
  • Stephen Harrell
  • Brian Burke

Abstract

Background. 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.

Suggested Citation

  • Brian Zoll & Pratik J. Parikh & Jennie Gallimore & Stephen Harrell & Brian Burke, 2015. "Impact of Diabetes E-Consults on Outpatient Clinic Workflow," Medical Decision Making, , vol. 35(6), pages 745-757, August.
    • Handle: RePEc:sae:medema:v:35:y:2015:i:6:p:745-757
    DOI: 10.1177/0272989X14556511
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    References listed on IDEAS

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    1. Suresh Chand & Herbert Moskowitz & John Norris & Steve Shade & Deanna Willis, 2009. "Improving patient flow at an outpatient clinic: study of sources of variability and improvement factors," Health Care Management Science, Springer, vol. 12(3), pages 325-340, September.
    2. Pablo Santibáñez & Vincent Chow & John French & Martin Puterman & Scott Tyldesley, 2009. "Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency’s ambulatory care unit through simulation," Health Care Management Science, Springer, vol. 12(4), pages 392-407, December.
    3. Thomas Rohleder & Peter Lewkonia & Diane Bischak & Paul Duffy & Rosa Hendijani, 2011. "Using simulation modeling to improve patient flow at an outpatient orthopedic clinic," Health Care Management Science, Springer, vol. 14(2), pages 135-145, June.
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