Universal electronic consultation program (e-consultation) of a cardiology department: long-term results in mortality
Authors: Iglesias D , Mazon-Ramos P M R , Portela-Romero M P R , Lopez-Barreiro L L B , Garcia-Castelo A G C , Pazos-Mareque J P M , Rey-Aldana D R A , Alvarez-Alvarez B A A , Martinez-Monzonis A M M , Cinza-Sanjurjo S C S , Gonzalez-Juanatey R G J 
Published: October 2022

Abstract

Background
Many health systems have initiated electronic consultation programs, although little is known about their impact on accessibility, safety and satisfaction (1). The implementation of integrated electronic medical record projects between healthcare levels allows all healthcare professionals access to all the clinical information of patients, which is a key factor in optimizing the management of healthcare resources, facilitating the communication between professionals and avoiding medical acts that do not add value, always from the premise of safety and quality for patients (2). In our model, a General Practitioner sends an e-referral to the Cardiology Department (CD). A Cardiologist can either answer without needing the face-to-face consultation, or schedule the patient for a single act consultation. In our health area, from 2009 to 2012, a “single act” cardiology consultation model was implemented, according to which the appointment includes, on the same day, all the complementary tests that might be necessary for the diagnosis. From 2013 until present, an electronic consultation or e-consultation model has been implemented; consisting of a telematic evaluation of the e-consultation by a cardiologist, who can either solve the GP's requests directly or book an appointment for the patient in person, in cases where it is considered necessary (3).

Purpose
The aim of this study is to assess the clinical impact of the implementation of a model of outpatient care that includes an initial electronic consultation (e-consultation), comparing it with a face-to-face single act model.

Methods
We selected patients with at least one visit to the Cardiology Department between 2010 and 2019. Using an interrupted time series regression model, we analysed the impact of incorporating the e-consultation into the healthcare model (started in 2013), evaluating: waiting time for care and mortality.

Results
We analysed 47,377 patients: 61.9% attended by incorporating the e-consultation and 38.1% in the face-to-face consultation model. The delay time for care in the e-consultation model (median [IQR]: 7 days [5–13]) was shorter than in the face-to-face model (median [IQR]: 33 days [14–81]), p&lt;0.001. The regression model for interrupted time series showed that the incorporation of e-consultation contributed a very important decrease in the delay of attention, remaining around 9 days, although with slight oscillations, Figure 1. The patients evaluated via e-consultation had less mortality (2.5% vs 3.9%, p&lt;0.001), Figure 2.

Conclusions
An outpatient care program that includes an e-consultation has shown to reduce waiting times significantly and is a safe model with a lower rate of mortality over the first year after the consultation.

Funding Acknowledgement
Type of funding sources: None.