(VP123) TRIAGING REFERRALS TO ECONSULTS (TREC): PROOF OF CONCEPT

Background: Electronic consults (eConsults) are provider to provider exchanges that allow primary care providers (PCP) to have timely access to specialist advice through an online platform often eliminating the need for traditional appointments. Long wait times and high rate of referral rejection are major frustrations for PCPs and patients. The currently available eConsult platforms depend on the PCP submitting the question on a unique platform and not through the usual referral processes. To meet high demands for specialist advice, we developed a proof-of-concept for a workflow that enables specialists to convert a referral request to advice only (eConsult) or advice and appointment during the triage process.

METHODS AND RESULTS: Since the launch of TReC in November 2022, there were 1753 referrals made to Endocrinology at The Ottawa Hospital. Of these, 164 (9%) were converted to an e-consult. Among the e-consults, 98 (5.6%) responses were Advice Only and 66 (3.8%) were Advice and Appointment. The median time between the referral being sent and the referring provider receiving advice was less than 1 day.

To assess PCP opinions on safety and acceptability for the specialist triaging the referral to this novel approach we contacted 60 PCP offices via telephone and used the feedback from 51 respondents to inform the creation of two satisfaction surveys, one for Advice Only and another for Advice and Appointment. Of the 12 respondents for the Advice Only survey, 75% agreed/strongly agreed that advice was easily recognizable and 91.7% agreed/strongly agreed that having advice only and no appointment was acceptable to them. There were no concerns regarding patient safety from 75% of respondents. There were 12 respondents for the Advice and Appointment survey. Of these, 91.7% of respondents felt that the advice was helpful and actionable, and 66.7% of respondents felt that it changed the management of their patient while they wait for an appointment.

Conclusion: Thus far we have established a safe and acceptable proof-of-concept for specialist-triaged eConsults. We will continue to seek PCP and specialist input as we spread and scale this initiative. Further work on cost benefit, time impact on providers, patient satisfaction and the development of consensus for types of referral questions that are best-suited for conversion to eConsultation is planned.