Assuring safety and efficacy of nurse triage for electronic consultation to improve access to specialty care.
2021
Ensuring delivery of timely, coordinated, safe and cost-effective specialty care is one of the most pressing issues facing our healthcare systems worldwide.1 Poor access to specialty care is common across health delivery organisations, with wait times as high as 6–12 months in some communities.2–4 For many specialties this is rooted in a shortage of specialist physicians.5 A key question, therefore, is how to maximise the efficiency and effectiveness of specialist use and access. The traditional primary–specialty care interface consists of a primary care provider (PCP) faxing a referral request to a specialist’s office without much accompanying diagnostic information and waiting to hear from the patient when an appointment has been scheduled (often on a first-come, first-served basis). The process is inefficient as it often results in avoidable specialist visits, duplicate diagnostic testing and delayed diagnoses for those patients who need specialist evaluation sooner than others who were referred to the same specialist.6–8 Newer models for improving access to specialty care are thus urgently needed.
Electronic consultation (eConsult), which provides a way for PCPs and their patients to obtain specialty expertise without an inperson patient visit to the specialist, has emerged as one potential solution for increasing access to specialty care through improved efficiency of consultation.1 eConsults are asynchronous virtual provider-to-provider consultations. They allow specialists to address consultative needs through chart review and communication with the referring provider, often without an inperson specialty care visit. They can be used to triage whether an inperson visit is needed, and when such a visit is needed, ensure adequate diagnostic work-up is completed before the visit. Ideally, this results in time saving for scarce specialists and improved wait times for patients.
Studies of early adopters of eConsult programmes in …
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