Outcomes Following Implementation of an Electronic Model for Perioperative Hematologic Consultation

Area of Science:

• Health Informatics
• Surgical Outcomes Research
• Hematology

Background:

• Electronic consultations (e-consults) for periprocedural hematologic questions were implemented at the VA Connecticut Healthcare System in 2011.
• The study investigates the impact of e-consult availability on referral patterns and surgical outcomes.

Purpose of the Study:

• To explore the relationship between the adoption of e-consults and surgical outcomes.
• To analyze referral patterns and consult volume changes following e-consult implementation.

Main Methods:

• A retrospective study of perioperative hematologic consultations from 2006 to 2018.
• Analysis of patient characteristics, indications, and outcomes, including time to consult resolution and operative morbidity (Clavien-Dindo classification).

Main Results:

• Annual consult volume increased by 5.8-fold from 2006 to 2018, with e-consults rising from 20% in 2011 to 92.3% in 2018.
• E-consult resolution time improved significantly compared to face-to-face (FTF) consultations (P < 0.002).
• No significant differences in operative morbidity, readmission rates, reoperations, or hematologic complications were observed between FTF and e-consults.

Conclusions:

• E-consults for perioperative hematologic issues were rapidly adopted and resolved faster than FTF consultations.
• The implementation of e-consults did not alter surgical outcomes or time to surgery, despite increased consult volume.