Impact of Diabetes E-Consults on Outpatient Clinic Workflow.
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.



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.



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.



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.
Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH (BZ, PJP, JG, SH)
Brian
B
Zoll
Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH (BZ, PJP, JG, SH)
Pratik J
PJ
Parikh
Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH (BZ, PJP, JG, SH)
Jennie
J
Gallimore
Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH (BZ, PJP, JG, SH)
Stephen
S
Harrell
Dayton Veterans Affairs Medical Center, Dayton, OH (BB)|Department of Internal Medicine, Wright State University, Dayton, OH (BB)
Brian
B
Burke
D003198:Computer Simulation / Q000706:statistics & numerical data; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D015233:Models, Statistical; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D019114:Remote Consultation / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data; D057188:Workflow
electronic consults; outpatient clinic; simulation; workflow