Impact of electronic consultation (e-consult) on timeliness and guideline concordance of workups leading to thyroid nodule fine-needle aspiration biopsy
Yoon SS, Wong DH, Reisman JI, Wormwood JB, Vimalananda VG. Impact of electronic consultation (E-consult) on timeliness and guideline concordance of workups leading to thyroid nodule fine-needle aspiration biopsy. Endocr Pract. Published online March 22, 2021. doi: 10.1016/j.eprac.2021.03.008. Online ahead of print.
OBJECTIVE: Electronic consultations (e-consults) are commonly used to obtain endocrinology input on clinical questions without a face-to-face visit, but there are sparse data on quality of care resulting from e-consults for specific conditions. We examined workups resulting in thyroid nodule fine-needle aspiration (FNA) biopsy to examine whether endocrinology e-consults were more timely and similarly guideline concordant as compared to endocrinology face-to-face visits, and whether endocrinology e-consults were more guideline concordant as compared to workups without endocrinology input.
METHODS: We conducted a retrospective chart review of 302 thyroid FNA biopsies conducted in the Veterans Affairs (VA) health system between 5/1/2017 and 2/4/2020 (e-consult, N=99; face-to-face visit, N=100; no endocrinology input, N=103). We used t-tests to compare timeliness and chi-square tests to compare the proportion of guideline-concordant workups. We used multivariable linear and logistic models to control for demographic factors.
RESULTS: FNAs preceded by endocrinology e-consult had more timely workups compared to those preceded by endocrinology face-to-face visits in terms of days elapsed between referral and FNA biopsy [geometric mean [95% confidence interval]: 44.7 [37.2, 53.7] days vs. 61.7 [52.5, 72.4] days, t(195)=2.55, P=0.01]. The difference in the summary measure of guideline concordance across groups was not statistically significant (P=0.38).
CONCLUSION: E-consults were faster than face-to-face consults and similar guideline concordant as compared to both face-to-face consults and no endocrinology input for workups resulting in FNA. Decisions about appropriate use of e-consults for thyroid nodules should account for these data while also considering potential benefits of direct patient-endocrinologist interaction for complex situations.