There is a nationwide shortage of pediatric specialists, delaying care for many patients. In some cases, children wait weeks or even months for appointments. But now, in a study published in the journal Clinical Pediatrics, researchers at UC Davis Health show that e-consults — in which primary care pediatricians have direct access to specialists — improve care for young patients.
Securely routed through the hospital's electronic health record (EHR), e-consults are asynchronous "meetings" between primary care physicians and specialists to discuss a patient's care. Once the primary provider receives the consult, they report next steps back to patients and their families.
"The pediatric specialist shortage can lead to longer wait times and poor health outcomes, especially for children with complex chronic conditions," said Ulfat Shaikh, professor of pediatrics for UC Davis Health, medical director of Healthcare Quality and first author on the study. "With e-consults, primary care physicians can ask for a second opinion, mitigating the need for families to make an in-person appointment with that specialist."
Raising awareness about e-consults
The research was conducted at UC Davis Health's pediatric health clinic, which cares for around 2,800 children and adolescents each year. During the study period, from January to December 2023, primary care pediatricians requested consults with specialists in allergy and immunology, dermatology, endocrinology, gastroenterology, infectious diseases, nephrology and pulmonology.
We found that e-consults were a big win for everyone. For families, they reduced time away from work and school, as well as transportation to and from visits. Primary care physicians were able to get more timely advice, giving them more information to provide better care."
-Ulfat Shaikh
One of the study authors' top priorities was to raise awareness about the service. While e-consults were first implemented at UC Davis Health in 2014, there was room for improvement. To encourage greater uptake, the study team initiated several efforts to educate and engage clinicians.
The first step was reaching out to the medical community within UC Davis Health. The team also worked with each specialty to develop its own e-consult protocols, which were then communicated to pediatric primary care physicians. To put e-consults front and center, the researchers adjusted the EHR's referral options to remind physicians they can select a doctor-to-doctor consultation.
Boosting patient access
Before the project, the e-consult rate was 14%. Following these interventions, that share increased to 43%. During the study, there were 65 e-consults, mostly for skin eruptions, infantile hemangiomas, alopecia and seizures. Dermatology received the most consults. On average, clinicians waited one day for subspecialists to respond with their recommendations. By comparison, patients waited an average 59 days for in-person appointments with specialists.
In addition to the raw data collection, the team interviewed several primary care pediatricians, specialists and a referral coordinator to better understand how they experienced these interactions.
"We found that e-consults were a big win for everyone," Shaikh said. "For families, they reduced time away from work and school, as well as transportation to and from visits. Primary care physicians were able to get more timely advice, giving them more information to provide better care. Specialists could use e-consults to order diagnostic tests before seeing patients in person, making those visits more efficient."
Because UC Davis Health has a large and rural catchment area, e-consults can be particularly valuable, mitigating the need for patients and their families to travel long distances for appointments.
"We found that e-consults helped primary care pediatricians get actionable advice from pediatric specialists for their patients," said Shaikh. "They reduced the wait times, as well as the need for in-person visits. That improves quality and value by making health care delivery more timely and efficient."
