Purpose: As patient volumes and complexity of hematology care increase, subspecialty provider efficiency is of utmost importance. We aim to improve efficiency by characterizing the nature and outcome of common hematology e-consults.
Background: Veterans Affairs Medical Centers pioneered electronic subspecialty consultation with the initiation of the e-consult system in 2011. An increase in number of hematology consultations at one VAMC from 391 in 2010 to 704 after e-consult implementation in 2013 was described by Cecchini et al (Blood, 2016).
Methods: A retrospective review of all hematology and oncology consults at one institution between April 1, 2016 and December 8, 2016 was performed. Cell counts, prior workup, diagnoses offered, age and comorbidities were determined for consults about complete blood count (CBC) abnormalities.
Results: 523 hematology/oncology consults were reviewed: 169 questioned CBC abnormalities, 76 consults were for anemia, and 38 consults were for thrombocytopenia. The most common diagnosis was iron-deficiency anemia (21.1% anemia consults). The most common hemoglobin value for anemia
consults was 9.0-9.9 g/dL (27.6% anemia consults). The most common platelet count for thrombocytopenia consults was 75k-100k (36.8% thrombocytopenia consults). Referring providers were significantly more likely to have initiated workup for anemia than for thrombocytopenia consults (71%
vs 29%, P < .0001). Consulting hematologists were significantly more likely to offer a diagnosis if basic workup had already been initiated (68% vs 39%, P = .0025). Age ≥ 70 years old had higher likelihood of 2-3 cell line abnormalities (RR 1.37, 95% CI, 1.02-1.82).
Conclusions: 169 consults about CBC abnormalities were reviewed. The most common reason for consult was anemia. Referring providers were significantly more likely to initiate a workup for anemia than for thrombocytopenia. There was a significantly greater likelihood of consultants offering a diagnosis if a basic workup had already been initiated. Increased education regarding mild anemia and basic workup of thrombocytopenia are areas of potential intervention to improve likelihood of diagnosis on initial consult and improve efficiency of the electronic consultation process.