In the JournalsPerspective

ID eConsultation associated with decrease in 30-day mortality

Infectious disease eConsultation was associated with decreased 30-day mortality and hospital readmissions in a study conducted at two rural hospitals.

“We initiated our inpatient eConsult service because we recognized the need for infectious diseases support for smaller hospitals in the Mayo Clinic Health System,” Aaron J. Tande, MD, an infectious disease specialist at the Mayo Clinic, told Healio. “We performed this study in order to evaluate the impact on patient care and demonstrate the value this service provides to our institution and to the medical community.”

In a retrospective, propensity matched, case-control study, Tande and colleagues identified the first 100 consecutive inpatients evaluated with eConsultation from July 2018 through December 2018 as cases, and created a pool of 300 controls using hospital census reports. They recorded patient outcomes, as well as the experience of referring providers and consulting ID specialists and what interventions were made.

Results of the study showed that patients who received ID eConsultation had a 70% reduced risk for death within 30 days compared with controls(adjusted OR = 0.3; 95% CI, 0.2-0.7). Results also showed a trend toward decreased readmission within 30 days (aOR = 0.4; 95% CI, 0.2-1.1).

Additionally, the study showed that 18 of 19 hospitalists surveyed were “very satisfied” with the ease of the consult and the use of electronic health records in the process. According to the study, interventions recommended through the eConsultations included antibiotic type change (94%), antibiotic duration change (55%), antibiotic de-escalation (48%), additional laboratory testing (48%) and consultation with services outside of infectious disease (6%).

“We believe that this study demonstrates the utility of an asynchronous approach to infectious diseases care for patients hospitalized at locations without in-person ID specialists. This approach allows a more in-depth evaluation of a patient than a typical ‘curbside’ phone call but avoids the complexity of synchronous/video telehealth,” Tande said. “This is a potential option for small hospitals that are on the same electronic record as larger hospitals that have infectious diseases specialists. We feel that the future of ID telemedicine should include a variety of options individualized to the complexity and needs of each individual patient and capabilities of each health care facility.” – by Caitlyn Stulpin

Disclosures: Tande reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Infectious disease eConsultation was associated with decreased 30-day mortality and hospital readmissions in a study conducted at two rural hospitals.

“We initiated our inpatient eConsult service because we recognized the need for infectious diseases support for smaller hospitals in the Mayo Clinic Health System,” Aaron J. Tande, MD, an infectious disease specialist at the Mayo Clinic, told Healio. “We performed this study in order to evaluate the impact on patient care and demonstrate the value this service provides to our institution and to the medical community.”

In a retrospective, propensity matched, case-control study, Tande and colleagues identified the first 100 consecutive inpatients evaluated with eConsultation from July 2018 through December 2018 as cases, and created a pool of 300 controls using hospital census reports. They recorded patient outcomes, as well as the experience of referring providers and consulting ID specialists and what interventions were made.

Results of the study showed that patients who received ID eConsultation had a 70% reduced risk for death within 30 days compared with controls(adjusted OR = 0.3; 95% CI, 0.2-0.7). Results also showed a trend toward decreased readmission within 30 days (aOR = 0.4; 95% CI, 0.2-1.1).

Additionally, the study showed that 18 of 19 hospitalists surveyed were “very satisfied” with the ease of the consult and the use of electronic health records in the process. According to the study, interventions recommended through the eConsultations included antibiotic type change (94%), antibiotic duration change (55%), antibiotic de-escalation (48%), additional laboratory testing (48%) and consultation with services outside of infectious disease (6%).

“We believe that this study demonstrates the utility of an asynchronous approach to infectious diseases care for patients hospitalized at locations without in-person ID specialists. This approach allows a more in-depth evaluation of a patient than a typical ‘curbside’ phone call but avoids the complexity of synchronous/video telehealth,” Tande said. “This is a potential option for small hospitals that are on the same electronic record as larger hospitals that have infectious diseases specialists. We feel that the future of ID telemedicine should include a variety of options individualized to the complexity and needs of each individual patient and capabilities of each health care facility.” – by Caitlyn Stulpin

Disclosures: Tande reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

    Perspective
    Raghavendra Tirupathi

    Raghavendra Tirupathi

    It is a well-known fact that ID consultation brings a lot of value to the case by decreasing mortality and improving outcomes including reducing length of stay in many diagnoses and syndromes. However, it may not be feasible to have an in-house ID physician in every hospital for several reasons. Many studies recently have shown the benefit of synchronous ID video teleconsultations with improved outcomes. As a practicing telehealth ID physician, I am amazed by this new study from Tande and colleagues, which is the first known study that used asynchronous tele ID service to provide electronic consults on patients in two tertiary hospitals with no in-house ID physicians. The study was able to show decreased 30-day mortality, decreased re-hospitalization and no changes in transfer rates to tertiary hospitals. This, in turn, will also lead to significant cost savings with minimal capital investment, infrastructure and time commitment on the part of the referring facility. It also provides flexibility to the consulting ID physicians to plan their daily schedule at their discretion. High rates of satisfaction were reported by the referring physicians. The downside of the study was that it is a case-control design. I practice in a rural community, and a program that is a good mix of options of robust antimicrobial stewardship program, asynchronous eConsultation, synchronous telemedicine and available hospital-to-hospital transfer for in person ID consultation would be an ideal setup for a critical access hospital that can improve outcomes for our sickest patients in these hospitals. I would love to see future studies focusing on this system. Reimbursement from Medicare and other payors for telemedicine is patchy and much is desired with respect to reform in that domain to help more ID physicians embrace telehealth.

    • Raghavendra Tirupathi, MD, FACP
    • Infectious Disease News Editorial Board Member
      Medical director, Keystone Infectious Diseases/HIV Chair, infection prevention,
      Summit Health
      Chambersburg, Pennsylvania

    Disclosures: Tirupathi reports no relevant financial disclosures.