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Electronic Consults in Pediatric Urology: Improving Specialty Access
Emma A. Harwood, MD, Evelyn James, MPH, Lily C. Wang, MD, PhD.
Maine Medical Center, Portland, ME, USA.
BACKGROUND: The growing demand for pediatric urology care is challenged by a national shortage of specialists, creating barriers to timely access. Electronic consultations (eConsults) offer a promising telehealth solution by allowing primary care providers (PCPs) to asynchronously obtain specialist input, potentially improving care efficiency while reducing the need for in-person visits. This study describes our initial experience implementing eConsults in pediatric urology.
METHODS: We conducted a retrospective review of all pediatric urology eConsults submitted at our institution between April 2024 and March 2025. Data collected included consult diagnoses, response times, acceptance or rejection, and need for in-person follow-up. We also estimated patient travel time and distance saved by foregoing in-person evaluations.
RESULTS: Thirty-two pediatric urology eConsults were reviewed. Of these, 73.5% were resolved without an in-person visit. The average response time was 1.3 days, with 53.1% addressed on the same day of submission. Most consults (21/32) were completed in 10-20 minutes. Common referral topics included scrotal concerns (28.1%) and penile anomalies (21.9%). Cases involving upper urinary tract abnormalities—such as vesicoureteral reflux, hydronephrosis, or congenital renal lesions—were more likely to require in-person follow-up. Estimated roundtrip travel times ranged from 24 to 232 minutes (mean: 110 minutes, median: 92 minutes), and distances ranged from 11.4 to 224 miles (mean: 88.3 miles, median: 76.7 miles).
CONCLUSIONS:
Pediatric urology eConsults show early potential to expand access, reduce unnecessary in-person visits, and decrease travel burdens for families—especially for low-complexity, non-operative conditions. Additionally, they serve as a platform to disseminate pediatric urology best practices to PCPs, promoting guideline-driven care. Future research should explore the long-term impact of eConsults on healthcare utilization, outcomes, and equitable access to pediatric urologic services.
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