Abstract
BACKGROUND: Specialists review referrals for appropriateness and urgency. Limited capacity results in specialists declining referrals leaving primary care providers (PCP), patients, and specialists frustrated. Since specialist availability is unlikely to improve significantly, innovative solutions are required. This study evaluated the feasibility, acceptability, safety and impact of a new referral triage option Triaging Referrals to eConsult (TReC) which enables specialists to provide advice in lieu of an appointment (advice only) or provide advice to support the PCP until the appointment occurs (advice and appointment). METHODS: Utilization metrics were prospectively collected (number (%) of referrals converted, time from receipt of referral to completion (response time) and specialist self-reported billing time. To assess PCP opinions on safety (advice was clearly identified and actionable) and acceptability (comfort in patient not seeing a specialist, additional time burden and support for expansion) two surveys, one for those referrals triaged to advice only and another for those triaged to advice and appointment, were faxed 14 days after the referral response. RESULTS: From November 1, 2022, to October 31, 2023, five specialties converted 930/16,880 referrals-656 (3.8%) to Advice Only and 274 (1.6%) to Advice and Appointment for an overall conversion rate of 5.5%. 192/1010 (19%) PCPs returned the survey with over 80% agreeing that the advice was easily recognizable, conversion to eConsult was acceptable and the advice was helpful and actionable. INTERPRETATION: Enabling specialists to provide advice to PCPs, often in lieu of an appointment, was acceptable, feasible with no major patient safety concerns.