MON-853 - The waiting game: providing advice-back while waiting for the appointment

Background: Timely access to specialist care remains challenging. As part of a novel triage workflow, Triaging Referrals to eConsult (TReC), specialists can provide advice back to referring providers to implement prior to in-person consultation (advice and appointment). This study aims to characterize endocrinology referrals triaged to this pathway, evaluate whether the advice provided was implemented before the appointment, and whether the planned appointment occurred.

Methods: We conducted a retrospective review of Endocrinology referrals submitted between November 2022 and August 2024 that were triaged to advice and appointment. Referrals were extracted from the electronic health record. Two reviewers independently coded the first 20 referrals and resolved discrepancies to reach consensus. The remaining referrals were divided among the reviewers for independent coding. Referrals were coded for clinical question and whether an appointment occurred. For those where an appointment occurred, the consultation note was reviewed to determine whether advice had been followed prior to appointment, and if not, whether the same advice was provided in the appointment. Reasons for missed appointments were extracted.

Results: Of 6666 accepted endocrinology referrals, 533 were triaged to advice and appointment during the study period. After excluding six referrals, 527 were analyzed. The most common referral reason was diabetes (27%), followed by hyperthyroidism (16%), and osteoporosis (11%). Seventy-five percent of patients attended their appointments. The most common reason for not attending was the inability to contact the patient (35%). Among patients who attended, the advice was followed prior to the appointment in only 36% of cases. When the advice was not followed, the same recommendation was provided after the consultation in 72% of the cases, despite a median wait time of 248 days.

Conclusion: The TReC pathway allows specialists to provide guidance while patients await consultation. However, advice is often not implemented prior to the appointment, diminishing its effectiveness. Future research should explore barriers to implementation of specialist advice.

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