Abstract Background Electronic consultations (e-consults) are asynchronous clinician to clinician exchanges within the electronic health record (EHR). Objective We sought to demonstrate the utility of e-consults in allergy/immunology (A/I) inpatient consultations. Methods Inpatients ≥ 18 years of age for whom an A/I consultation was requested were eligible for an e-consult. An e-consult was completed if considered appropriate by the A/I physician with recommendations made in the EHR. In-person consultation was performed for inpatients if deemed necessary. Likert scale satisfaction data was collected from requesting providers after the e-consultation. Cost was calculated using time-based billing codes plus the cost of penicillin allergy evaluation, if appropriate. Results Of the 109 inpatient consults, 78 (71.6%) were completed through an e-consult, and 31 (28.4%) were completed by an in-person consult. The most common indication for inpatient consult was evaluation of penicillin allergy in 73 (67%) patients. The most common reason to complete an in-person consult was the need to complete penicillin skin testing in 17 of the 31 (55%) patients. E-consults were completed in less time than in-person consults (15 minutes [IQR: 10 to 15], versus 60 minutes [IQR: 45 to 60], p < 0.001 and had a shorter turnaround time (1 hour [IQR: 0.5 to 2], versus 7 hours [IQR: 3 to 19], p < 0.001. Management recommendations were followed at a similar rate regardless of type of consult (88% of e-consults versus 96% of in-person consults, p=0.162). 97% of requesting providers reported an “excellent” or “good” impression of e-consults. E-consults were less costly than in-person consults. Conclusions E-consults have utility in providing inpatient allergy/immunology consultation, and may have advantages over in-person evaluation, while adequately maintaining provider satisfaction.
Inpatient Electronic Consultations (E-consults) in Allergy/Immunology