January 26, 2020
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ID eConsultation associated with decrease in 30-day mortality

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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.