Infectious Diseases E-Consults vs In-Person Care: Hospital Mortality and Readmission Outcomes

Inpatient infectious diseases (ID) e-consults were associated with outcomes comparable to those of in-person consultations in a retrospective study presented at IDWeek in Washington, DC, held from October 21 to 24, 2026. Although patients receiving e-consults had a higher rate of bacteremia diagnoses and longer overall hospital stays, investigators found no statistically significant differences in in-hospital mortality, 30-day mortality, or 30-day readmission.

The poster, “Comparable Patient Outcomes Following E-consults vs In-Person ID Consults at a Tertiary Care Hospital,” examined care at a 380-bed hospital in Blair County, Pennsylvania. Researchers compared 115 patients initially evaluated via asynchronous ID e-consults with 120 patients initially evaluated via in-person consultations in an earlier period.

The authors described their findings as an initial assessment and recommended additional studies across different health care delivery settings. Their conclusion suggests that e-consults may offer an acceptable alternative to in-person care, while recognizing the need for further evaluation.

Evaluating an Alternative to Synchronous Telemedicine

The poster identifies telemedicine as a way to provide specialty ID care to remote and underserved areas. However, synchronous telemedicine requires dedicated audiovisual equipment and secure, stable internet connectivity. Local staff must also be available to assist with consultations, creating additional implementation requirements.

Inpatient asynchronous e-consults offer another approach. The researchers noted that evidence on their effectiveness, particularly patient outcomes, remains limited. Their study evaluated this model in response to the hospital’s request for ID e-consults during the COVID-19 pandemic and an ID physician outage.

Investigators retrospectively reviewed charts for 115 patients initially evaluated through e-consults between April and July 2020. The comparison group consisted of 120 patients selected by a random number generator from 398 patients initially evaluated through in-person ID consultations between April and July 2019. The groups, therefore, represented different periods rather than concurrent consultation services.

Comparing Patient Characteristics and Diagnoses

The researchers reported that the groups were balanced with respect to age, race, Charlson Comorbidity Index, and intensive care unit status at the time of consultation. Median age was 63 years in the e-consult group and 65 years in the in-person group.

Both groups had a median Charlson Comorbidity Index of 4. At the time of consultation, 11 patients in the e-consult group, or 9.6%, were in the intensive care unit, compared with 12 patients, or 10%, in the in-person group. Previous hospitalization within 6 months was reported for 44% of patients in each group.

Bacteremia diagnoses were more frequent among patients receiving e-consults. Investigators identified bacteremia in 39 patients in that group, or 34%, compared with 24 patients, or 20%, receiving in-person consultations. The difference was statistically significant, with a P value of 0.016.

Mortality and Readmission Differences Were Not Significant

In-hospital mortality occurred in 3 patients receiving e-consults (2.6%), compared with 6 patients receiving in-person consultations (5.0%). The P value was 0.50. At 30 days, mortality was reported in 8 patients in the e-consult group (7.0%) and 7 in the in-person group (5.8%), with a P value of 0.72.

Thirty-day readmission occurred in 30 patients receiving e-consults (26%), compared with 22 patients receiving in-person consultations (18%). That difference also was not statistically significant, with a P value of 0.15.

Hospital length of stay differed between the groups. Median overall stay was 8 days for e-consult patients and 6 days for in-person consultation patients, with a P value of 0.004. However, the median length of stay after ID consultation was 4.4 days vs 4.0 days, respectively, a difference that was not statistically significant.

The median time from admission to ID consultation was 57 hours in the e-consult group and 21 hours in the in-person group. That difference had a P value of less than 0.001.

Further Evaluation Across Settings Is Needed

“ID e-consults were comparable to in-person with respect to in-hospital mortality, 30-day mortality, and 30-day readmission despite higher rates of bacteremia diagnoses,” the researchers concluded. This finding was accompanied by a significant difference in overall hospital stay, but not in the length of stay following consultation.

The authors recommended additional studies to assess the comparability of remote and in-person ID consultation across different health care delivery settings. Their initial findings support further examination of asynchronous consultation as an alternative model for specialty ID care.

Poster authors: Sui Kwong Li, MD; James Harrigan, MD, PharmD; Sarah Burgdorf, MD, PhD; Rima C. Abdel Massih, MD; and John W. Mellors, MD.

Affiliations: Division of Infectious Diseases, University of Pittsburgh Medical Center; and Infectious Disease Connect, Inc.

Source: IDWeek poster P-1291, “Comparable Patient Outcomes Following E-consults vs In-Person ID Consults at a Tertiary Care Hospital.”