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Kidney Week

Abstract: PO0576

Nephrology eConsultation: The "Curb Side" Consult for the 21st Century

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Levy, David, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
  • Grewal, Rickinder, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
  • Liebman, Scott E., University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
  • Le, Thu H., University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
Background

The Nephrology Division at the University of Rochester receives on average 120 new outpatient referrals per month. While every effort is made to see new referrals promptly, this demand exceeds the capacity to evaluate these patients in a timely manner. To decrease waiting time and increase efficiency, we developed a Nephrology eConsultation program. Here we report our experience with time and value-based metrics as well as primary care provider (PCP) satisfaction.

Methods

After a year-long pilot phase, in September 2019 we expanded the eConsult program to provide electronic nephrology consultation to PCPs across the University health system for renal-related issues such as mild to moderate acute kidney injury, CKD, electrolyte disturbances, and proteinuria.

Results

Within the first 8 months of the expanded program, 110 eConsult requests were received. Of these, 62 were deemed medically appropriate and completed, with 46 (74.2%) related to acute kidney injury, CKD, or azotemia, 6 (9.7%) related to electrolyte imbalances, and 4 (6.5%) related to proteinuria. The mean time for a nephrologist to complete an eConsult was 18.3 minutes (Table 1). Of the 48 deemed inappropriate for eConsults, 36 (75%) were converted to in-person visits due to complexity (Table 2). All eConsults were completed within 67 hours (mean time 15.5 hours). Survey of PCP satisfaction showed that 68% of PCPs were very satisfied and 32% were satisfied with the nephrology eConsult program.

Conclusion

eConsultation in Nephrology has the potential to provide timely, cost effective, and remote guidance to PCPs for more straightforward questions, while prioritizing the limited resource of face-to-face nephrology consultation for patients with more complex diseases. This also offers financial advantages, as the work relative value units (wRVUs) for eConsult is 0.7, or up to 2.8 wRVUs per hour in our model. eConsultation in Nephrology could also be integrated with the rapidly evolving field of telemedicine to improve delivery of care remotely and increase provider and potentially patient satisfaction.

Data

Funding

  • Clinical Revenue Support