E-consults: an effective way to decrease clinic wait times in rheumatology.

Clinic wait times in rheumatology remain a persistent challenge, especially for referrals with positive antinuclear antibody (ANA) results. Prior research has shown that such referrals often do not lead to rheumatic diagnoses, yet they still require timely evaluation. No prior work had resolved how to streamline these referrals without compromising diagnostic accuracy. This gap motivated the exploration of alternative consultation methods. Traditional in-person visits can be resource-intensive and contribute to long wait times. Digital health tools like E-consults have been proposed as a solution in other specialties. However, their impact on rheumatology workflows remains understudied. The need for efficient triage of ANA-positive referrals is clear. Understanding how E-consults affect diagnostic outcomes and clinic wait times is essential. This study aimed to assess whether E-consults could reduce wait times while maintaining diagnostic quality. The results could inform broader adoption of digital triage in rheumatology.

This study aimed to evaluate the effect of E-consults on clinic wait times and resource utilization for patients with positive ANA referrals. The specific problem addressed was the inefficiency of in-person referrals for ANA-positive cases, which often do not result in rheumatic diagnoses. The motivation stemmed from the need to reduce clinic wait times without sacrificing diagnostic accuracy. Researchers proposed that E-consults could serve as a triage tool. The study focused on whether E-consults could decrease wait times for in-person visits. It also examined resource use differences between E-consults and in-person referrals. The goal was to determine if E-consults could be a viable alternative. The findings could inform clinical workflow improvements in rheumatology.

The study used a pre-post design to assess E-consult implementation for ANA-positive referrals. Researchers reviewed referrals from January 2015 to March 2017. A statistical process control chart tracked monthly average wait times. The chart identified special cause variation in wait times. Final diagnoses, wait times, and resource use were compared between E-consults and in-person visits. Data collection included patient demographics and diagnostic outcomes. Researchers analyzed whether E-consults reduced the need for in-person visits. They also compared laboratory and imaging use between the two groups.

E-consults were used in 44% of referrals after implementation in August 2015. Seventy-six percent of E-consult cases did not require in-person follow-up. A control chart showed a significant shift in wait times from June 2016 to January 2017. This shift suggested a temporal link between E-consults and reduced wait times. Only 11 patients received a rheumatic diagnosis from ANA-positive referrals. The majority of patients (73%) did not have a rheumatologic diagnosis. E-consults used more labs than in-person visits, but not significantly. In-person visits used more imaging, and this difference was statistically significant.

The authors suggest that E-consults may be an effective way to manage ANA-positive referrals without increasing resource use. They propose that E-consults could help reduce clinic wait times in rheumatology. The findings indicate a possible temporal association between E-consults and improved wait times. The study suggests that most ANA-positive referrals do not require in-person visits. The authors note that E-consults may help triage patients more efficiently. They suggest that digital tools could support better workflow in outpatient rheumatology. The results do not confirm causation but suggest a potential benefit. The authors conclude that E-consults may be a viable alternative to traditional referrals.