Electronic consultation use by advanced practice nurses in older adult care-A descriptive study of service utilization data

Ramtin Hakimjavadi; Sathya Karunananthan; Cheryl Levi; Kimberly LeBlanc; Sheena Guglani; Mary Helmer-Smith; Erin Keely; Clare Liddy

doi:10.1002/nop2.1476

Electronic consultation use by advanced practice nurses in older adult care-A descriptive study of service utilization data

Nurs Open. 2023 Apr;10(4):2240-2248. doi: 10.1002/nop2.1476. Epub 2022 Nov 14.

Authors

Ramtin Hakimjavadi^{1

2}, Sathya Karunananthan^{2

3}, Cheryl Levi⁴, Kimberly LeBlanc^{5

6}, Sheena Guglani², Mary Helmer-Smith^{7

8}, Erin Keely^{9

10

11}, Clare Liddy^{2

11

12}

Affiliations

¹ Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
² C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.
³ Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
⁴ Emergency Department Outreach Program, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁵ Nurses Specialized in Wound, Ostomy, and Continence, Ottawa, Ontario, Canada.
⁶ Advanced Practice Nurse (Wound, Ostomy, and Continence), KDS Professional Consulting, Ottawa, Ontario, Canada.
⁷ School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
⁸ Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.
⁹ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁰ Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada.
¹¹ eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada.
¹² Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Abstract

Aims and objectives: To describe characteristics of service utilization by advanced practice nurses (APNs) employing an electronic consultation (eConsult) service in their care for older adults.

Background: Canada's aging population is projected to place unprecedented demands on the healthcare system. APNs, which include clinical nurse specialists (CNSs) and nurse practitioners (NPs), are nurses with advanced knowledge who can independently provide age-appropriate care. eConsult is a secure web-based platform enabling asynchronous, provider-to-provider communication. APNs can send and receive eConsults to address patient-specific concerns.

Methods: This is a retrospective analysis of eConsult utilization and user survey data for cases completed in 2019, reported in line with the STROBE guidelines. Eligible eConsults included those that had APN involvement (as a referrer or responder) and were concerning an older patient (≥65 years). Descriptive statistics were used to analyse service utilization and survey response data.

Results: Of 430 eligible eConsults, 421 (97.9%) were initiated by NPs and the rest by physicians. 23 (5.3%) were received by a CNS, of which 14 (3.3%) involved an NP-to-CNS exchange. Median specialist response interval was 0.9 days. 53% of eConsults was for dermatology, haematology, cardiology, gastroenterology and endocrinology. 73% of eConsults avoided a face-to-face referral after the consultation. In 90% of eConsults, APNs rated the service as helpful and/or educational.

Conclusions: Through eConsult, APNs can collaborate with each other and physicians to access and provide a breadth of advice facilitating timely specialist-informed care for older patients, thus helping to alleviate some of the demands placed on the healthcare system.

Relevance to clinical practice: There is an opportunity for APNs to further adopt eConsult into their clinical practice, and this can, in turn, support the integration of the APN role in the health workforce.

Patient or public contribution: Current APN eConsult users were involved in the study design and interpretation of results.

Keywords: advanced practice nursing; electronic consultation; interprofessional healthcare; older adults; telehealth; telemedicine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Delivery of Health Care
Hematology*
Humans
Nurses*
Remote Consultation*
Retrospective Studies