Evaluation of an Electronic Consultation Service for COVID-19 Care

Jatinderpreet Singh; Gary E. Garber; Erin Keely; Sheena Guglani; Clare Liddy

doi:10.1370/afm.2807

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Figure 1.
Timeline of emerging themes of COVID-19 eConsults and policy changes in Ontario.
BCG = bacille Calmette-Guerin; eConsult = electronic consultation.
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Figure 2.
Outcomes of COVID-19 eConsult cases (N = 282 cases).
BASE = Building Access to Specialists through eConsultation; eConsult = electronic consultation.
^a Response option available only for the Champlain BASE eConsult service.
^b Response option available only for the Ontario eConsult service.
Note: Survey results were unavailable for 7 eConsult cases (all in the Ontario eConsult service).
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Figure 3.
Referral outcomes of COVID-19 eConsult cases (N = 282 cases).
eConsult = electronic consultation.
^a Response option available only for the Ontario eConsult service.
Note: Survey results were unavailable for 7 eConsult cases (all in the Ontario eConsult service).

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Table 1.

Content of Clinical Questions Asked of COVlD-19 Specialists by eConsult (N = 51 Cases)

Content Topic	eConsult Cases, No. (%)	Sample Questions
Precautions or workplace accommodations for high-risk/special populations	17 (33.3)	“48 F in regards to covid prevention in her son with stable cystic fibrosis and husband with history of CAD with stents. She works at kindergarten – JK and SK as early childhood educator... Wants leave of absence for indefinite period.… Please provide your suggestions.”
Diagnostic clarification and/or need for COVID-19 testing	15 (29.4)	“…two patients recently with sudden onset anosmia...Had read that anosmia can be presenting feature of Covid. Neither is very unwell. Is there any thought of testing these folks? Is there anyone doing research on anosmia and Covid?”
Guidance on self-isolation and return to work criteria	12 (23.5)	“…42-year-old female who...tested positive for COVID-19...She followed the isolation protocols and has clinically completely recovered...however she continues to intermittently test positive...patient is wondering at what point should she discontinue her self quarantine...”
Personal protective equipment and mask exemptions	6 (11.8)	“…For people working in clinics – we have limited 90-95% of in person visits in the clinic. But for the people that we do so-what is reasonable PPE for us and nurses to use when we are seeing people without respiratory symptoms. With community spread any touch could potentially lead to transmission of COVID 19.”
Management of chronic symptoms of COVID-19	5 (9.8)	“61 yo F COVID positive swab April 3rd. She started with mild respiratory symptoms, then turned to gastroenteritis type symptoms.… She continues to have sinus burning sensation with headache, sore throat, runny nose, sneezing, burning, weepy eyes, fatigue, muscle aches and diarrhea (now June). Are these in keeping with ‘long haulers’ of covid 19? Is there any specific treatment to try?...”
Pharmacologic therapies/immunizations to prevent COVID-19	2 (3.9)	“62F born in Vietnam, received BCG immunization at age 10...patient has been doing research on the benefits of getting a BCG booster in preventing COVID-19.…what is the current recommendation for BCG immunization and boosting and has this changed since COVID-19?”
Other (not related to COVID-19)	2 (3.9)	“34F with positive Mantoux (2nd step 15 mm) with normal CXR...possible TB exposure in fall 2018...she has been referred to ID...Does she need treatment for active TB...?”

BASE = Building Access to Specialists through eConsultation; BCG = bacille Calmette-Guerin; CAD = coronary artery disease; CXR = chest radiograph; eConsult = electronic consultation;
F = female; ID = infectious diseases; JK= junior kindergarten; PPE = personal protective equipment; SK= senior kindergarten; TB = tuberculosis; yo = year old.
Notes: Content analysis limited to the 51 eConsults submitted to the Champlain BASE service because data-sharing agreement was not yet in place with the Ontario service. Percentages total to more than 100% because some cases included multiple topics.