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BMC Health Serv Res. 2017 Jun 23;17(1):433. doi: 10.1186/s12913-017-2375-0.

A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield.

Author information

Veterans Affairs/Robert Wood Johnson Foundation, Clinical Scholars Program, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Department of Otolaryngology, University of California, San Francisco, CA, 94143, USA.
Department of Medicine, University of California, San Francisco, CA, 94143, USA.
Renal Center at Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue. Bldg 100, Room 342, San Francisco, CA, 94110, USA.
Department of Medicine, University of California, San Francisco, CA, 94143, USA.



Electronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case).


Retrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014. Electronic consultation requests were reviewed for the presence/absence of consult domains: symptom acuity/severity, diagnostic evaluation, concurrent medical conditions, and attempted diagnosis. Logic regression was used to examine the association between completeness of consult requests and scheduling an ambulatory clinic visit. Surgical yield was also calculated, as was the percentage of patients requiring unanticipated healthcare visits.


In 2014, 1743 electronic consultations were submitted to general surgery. Among the 150 abstracted, the presence of consult domains ranged from 49% to 99%. Consult completeness was not associated with greater likelihood of scheduling an ambulatory visit. Seventy-six percent of consult requests (114/150) were scheduled for a clinic appointment and surgical yield was 46%; without an eConsult system, surgical yield would have been 35% (p=0.07). Among patients not scheduled for a clinic visit (n=36), 4 had related unanticipated emergency department visits.


Econsult systems can be used to safely optimize the surgical yield of a safety-net general surgery service.


Ambulatory safety; Electronic consultation; Health system redesign; Patient-centered medical neighborhood; Surgical yield

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