• David E Winchester, Anita Wokhlu, Juan Vilaro, Anthony A Bavry, Ki Park, Calvin Choi, Mark Panna, Michael Kaufmann, Matthew McKillop, and Carsten Schmalfuss.
• Malcom Randall VA Medical Center, 1601 SW Archer Rd, Box 111-D, Gainesville, FL 32608. Email: David.winchester@va.gov.
• Am J Manag Care. 2019 May 1; 25 (5): 250-253.

ObjectivesWe adopted e-consults within an active referral management (ARM) process for our Veterans Health Administration (VHA) outpatient cardiology clinic to reduce clinic wait times.Study DesignProspective multiphase cohort study.MethodsOur ARM process consisted of reviewing all incoming consult requests for our outpatient clinic and triaging the requests to either an e-consult or a clinic visit. The primary outcome was wait time for an appointment in our clinic.ResultsMedian wait time prior to the ARM process was 24 days. After implementation of the ARM process, wait times decreased to 13 days (46% reduction). Approximately 60% of incoming consults could be triaged into e-consults, predominantly by managing stable diseases or minor symptoms.ConclusionsE-consults and ARM of clinical referrals were effective at reducing wait times for our outpatient VHA cardiology clinic. The majority of clinical referrals could be handled through an e-consult and did not require an in-person clinic visit.

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