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PSNet: Patient Safety Network
Journal Article

Minding the gaps: assessing communication outcomes of electronic preconsultation exchange.

Price EL, Sewell JL, Chen AH, et al. Joint Commission journal on quality and patient safety. 2016;42:341-54.

Outpatient practices are increasingly using electronic referrals, or eConsults, to obtain clinical input from specialists because of insufficient access to subspecialty care. In an eConsult, the referring clinician (usually a primary care physician) will provide clinical information to the specialist via email or a web-based system. The specialist will review the information in the electronic medical record and decide whether further testing, treatment, or an in-person consultation is necessary. This retrospective study evaluated the safety of the electronic referral process by reviewing the medical records of patients who had been referred to a gastroenterology clinic and were not scheduled for in-person appointments. Investigators sought to determine the number of patients deemed not to require appointments and how many remained unscheduled. Emergency care or hospitalization for the referral complaint was rare overall; however, among patients whose electronic referrals remained unresolved (when investigators could find no decision regarding need for in-person visit and symptoms prompting referral were not addressed in the medical record), more than 70% were at moderate to high risk of potential harm. These cases included many patients who had no documented health care visits in the 6 months after the electronic referral was placed. Although the authors did not identify any definitive cases of harm attributable to failures of the electronic referral process, this study does highlight the need for robust tracking of eConsults to ensure appropriate follow-up by referring providers.