Provider-to-provider telephone consultations for cardiovascular concerns: A retrospective cohort study evaluating safety and efficacy

Introduction: General internal medicine (GIM) clinics receive many referrals for cardiovascular concerns without clinical red flags. These can be addressed through provider-to-provider telephone consultations that support primary care providers (PCPs) in managing patient concerns. This modality of care demonstrates how health systems can manage rising referral volumes and complexity of patient care needs while empowering PCPs. We aimed to evaluate the safety and efficacy of provider-to-provider telephone consultations between GIM and PCPs for cardiovascular diagnoses. Methods: We conducted a retrospective cohort study of patients referred to GIM at a Canadian tertiary-care centre for whom the referral was resolved through a provider-to-provider telephone consultation between 2017 and 2019. Data collected included clinical diagnoses, previous cardiac assessments, consults and recommendations, and whether patients had in-person encounter(s) within 6 months of the consult. Results: In 2 years, 130 telephone consultations were completed. Triage was informed by 84% of patients having had previous cardiac testing and 29% having seen a cardiologist previously. Diagnoses managed included hypertension (>20%), atrial fibrillation (15%), and palpitations (12%). Over 90% of patients did not require direct specialist care within 6 months. Only 2 patients (<2%) may have benefited from an upfront in-person assessment by GIM. Discussion: Telephone consultations between providers avoided the need for direct patient care in >90% of cardiovascular referrals without clinical red flags. We observed no associated adverse outcomes. Telephone consults improved wait times to access GIM care. Formalizing telephone communication programs between internists and PCPs provides a low-barrier, easily implementable access point for specialty care.