Title: Implementing the Brief Consult Note to Reduce Consult Turnaround Times in the Emergency Department

Author: Osiel Cecenas

Area of Concentration (Petal): Health delivery & Improvement Research

Specialty (if any): Emergency Medicine 

Keywords: length of stay, turnaround time, consultant

Background: Specialty consultations occur in up to 40% of emergency department (ED) visits and can comprise two-thirds of the length of stay (LOS), significantly affecting ED capacity and patient experience.

Objective: This study measures the impact of implementing a brief consult note (BCN) tool on ED consult turnaround (TAT) times and overall ED LOS.

Methods: We deployed the BCN tool, an abbreviated note template that allows specialty services to convey final recommendations to ED clinicians. We conducted a pre-post study comparing the 11-month periods before and after this intervention. Ten of the highest-volume ED consulting services were included for analysis. The primary outcome was median consult TAT. Secondary outcomes included the proportion of consults completed under 90 minutes and time from Doc until ED Disposition. We used quantile regression to calculate changes to median consult TAT and time from Doc until Disposition; chi-square analysis was used to compare the proportion of consults completed within 90 minutes pre-and post-intervention.

Results: Median consult TAT decreased by eight minutes (118 to 110, 95% CI 1-15, p=0.02), and the proportion of consults completed within 90 minutes increased by 3% from 39% to 42% (p= 0.01). Among BCN utilizers, there was a reduction in median TAT by 69 minutes (121 to 52, 95% CI 58 to 80, p<0.001). Subgroup analysis of the five services with >20% BCN utilization demonstrated a reduction in median TAT by 46 minutes (123 to 77, 95% CI 36-56, p<0.001). The Doc until ED Disposition time was unchanged for ED encounters involving these five services but increased significantly for the services with low BCN utilization by 45 minutes (234 to 279, 95% CI 33-59, p<0.001).

Conclusions: We implemented a BCN tool in the ED and observed a significant decrease in median consult TAT and a higher proportion of consults completed under 90 minutes. Consult services with high BCN utilization demonstrated the most significant improvements and notably did not experience worsening time until ED Disposition, unlike consult services with low BCN utilization.