Enhancing inpatient consultation workflow through implementation of an EHR direct-paging consult order system

Obtaining specialist consultant recommendations are an important part of hospitalized patient care, particularly those with complex medical conditions. However, in large medical systems, consultation workflows can be burdensome for all parties. To improve workflow efficiency between the inpatient primary team and consultants at our institution, we expanded a paging workflow implementation integrated directly into the hospital's electronic health record (EHR).

This direct-paging consult order was expanded to three pediatric specialty services (endocrinology, psychology, and surgery). Comparing 6-months pre- and post-implementation, our primary outcome measures were time from consult order page sent to time of a) consultant chart access and b) consultant note filing. Our secondary outcome measures were the direct-paging consult order's usability and satisfaction for stakeholders (end-users) who may place and receive consults.

Across specialties, the estimated mean time from consult order page placement to chart access decreased from 2.12 (SE = 0.29) hours to 0.96 (SE = 0.31) hours (p = 0.007). The estimated mean time to consult note signed decreased, but did not significantly change (14.14, SE = 1.22 to 11.25, SE = 1.33 h; p = 0.110). Those who placed consults were more satisfied with the direct-paging consult order workflow compared with the traditional paging consult order workflow. End-users self-reported perceived overall reduction of inpatient workload burden. For consultants, there was no change in satisfaction with receiving consult pages from the direct-paging consult order.

Implementation of the direct-paging consult order system for a variety of pediatric specialties led to lower times for consultants to access patient charts and improved consultation workflow satisfaction for end-users placing consults.