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Kidney Week

Abstract: FR-PO249

Using E-Consults in Nephrology to Improve Renal Care: A 5-Year Experience in the Miami VAMC

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Armstrong, Antonio A., Jackson Memorial Hospital, Orlando, Florida, United States
  • Mendez Castaner, Lumen Alberto, Jackson Memorial Hospital, Orlando, Florida, United States
  • Cristea, Emilian A., University of Miami, Lauderhill, Florida, United States
  • Cuebas-Rosado, Lorena, Miami VA Hospital, Miami, Florida, United States
  • Soberon, Daniel J., Miami VA Hospital, Miami, Florida, United States
  • Venkat, Vasuki N., Miami VA Hospital, Miami, Florida, United States
  • LadinoAvellaneda, Marco A., Miami VA Medical Center/University of Miami/ Jackson Memorial Hospital, Plantation, Florida, United States
Background

Electronic consultations (E-consults) are defined as asynchronous, consultative, provider-to-provider communications within a shared electronic health record or web-based platform. The primary objective of an E-consult is to expedite and improve patient care by increasing access to specialty knowledge and expertise without the need for a face-to-face visit. E-consults provide a virtual clinical discussion by the specialist after the information is reviewed and returned with suggestions and recommendations. Our review study evaluates our 5-year experience using this consultative method.

Methods

This is a retrospective study that evaluated 745 E-Consults for the Nephrology section at the Miami VAMC during a 5-year period (2013-2018). Data was obtained and included the following: gender, age, reason for the consult, time to answer the consult and improvement of the patient’s condition after the consult. A simple survey was given to the referring health care provider to evaluate the quality of the E-consult and their satisfaction.

Results

The nephrology section answered the consult in an average of 40 hours. 95% were male patients (N=708), median age was 62.3 years old. The reasons for consulting: Chronic Kidney Disease 54% (N=401), proteinuria workup and co-management 16% (N=118), uncontrolled hypertension 12% (N=90), recommendations and clearance to use medications in patients with CKD grades III, IV and V 7% (N=52), electrolyte and metabolic disorder management 6% (N=43), contrast-induced nephropathy prevention 5% (N=41). 82% (N=611) of the E-consults resolved the referral, 18% (N=134) of the E-consults needed the patient to have a face-to-face encounter. In a scale from 1-5, where 5 is the highest and 1 lowest, health care providers satisfaction was 4.5, quality of the E-consult was 4.7, consult answer their concerns was 4.4. All health care providers (N=22) stated that they will continue to use E-consults.

Conclusion

E-consults improve the care of patients with renal conditions. They decrease waiting times and facilitate the access and evaluation of patients that need evaluation of a nephrologist. Referring health care providers were satisfied with the outcome of the E-consult and will continue to use in the renal care of their patients.