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Improving Access to Speciality Care Through Electronic Consultation: A Single-Center Evaluation of eConsult Utilization and Efficiency
Winston Tan, BS1, Wilson Dong, BS1, Samuel Z. Lee, BA1, Joseph Y. Liao, BS1, Nadia Abdo, DO2, Ricardo M. Munarriz, MD2, David S. Wang, MD2.
1Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA, 2Boston Medical Center, Boston, MA, USA.
BACKGROUND:Access to specialty care, including urology, remains a significant problem in many health systems. Increased referrals from PCPs with shortage of urologic specialists have led to long appointment wait-times and delays in care for common urologic conditions. Electronic consultation (eConsult) may present a solution, allowing referring providers to obtain rapid specialist input. We assessed the ability of eConsult services to improve clinical efficiency and access to care.
METHODS: We retrospectively reviewed all urology eConsults at our institution between 2023 and 2025. Collected eConsult variables included: initiation-to-completion time, in-person visit conversion rates, and primary urologist diagnoses. We used the in-person conversion rates for common diagnoses as a proxy for clinical efficiency analyses.
RESULTS: A total of 351 eConsults were reviewed, with an average resolution time of 10.2 hours and over half (51.9%) of cases being resolved without the need for an in-person visit. The four most common diagnoses consulted for were hematuria/abnormal urinalysis (23.9%), renal masses/cysts (19.7%), BPH/LUTS (16.2%), and elevated PSA (9.4%). Immediate case resolution occurred in 89.9% of renal mass/cyst cases and 76.2% of hematuria cases received expedited cystoscopy (CT urogram done prior to urology visit), avoiding initial in-person consultations. 45.5% of elevated PSA cases did not require an in-person visit, with the remaining cases receiving prostate MRI and repeat PSA before seeing urology (Table 1).
CONCLUSIONS: We found that eConsults were highly effective at our institution, reducing the number of in person visits and allowing for earlier triage of patients requiring urologic evaluation. Over half of patients did not require an in person urology visit. Our findings suggest that implementation of this service can improve and expedite patient care and increase specialty access.
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