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BACKGROUND: Coronavirus disease 2019 (COVID-19) necessitated wide-scale adoption of telemedicine (TM) and restriction of in-person care. The impacts on allergy/immunology (A/I) care delivery are still being studied. OBJECTIVE: To describe the outcomes of rapid transition to TM-based care (video visit followed by in-person visits dedicated to diagnostic and therapeutic procedures when needed) at an academic A/I practice during COVID-19. METHODS: Demographic data were compared for patients originally scheduled for in-person visits between March 10, 2020, and April 30, 2020, who completed a video visit instead between March 10, 2020, and June 30, 2020, and those who did not. Appointment completion, diagnoses, and drug allergy and skin testing completion were compared for visits between March 10, 2020, and June 30, 2020, and 1 year prior (March 10, 2019-June 30, 2019). RESULTS: Sixty-nine percent (265 of 382) of patients originally scheduled between March 10, 2020, and April 30, 2020, were able to complete video visits. Patients who completed video visits were more likely to be white (52% vs 33%; P < .001), English-speaking (96% vs 89%; P = .01), and privately insured (70% vs 54%; P = .004). With TM-based care compared with in-person care, there were significant decreases in environmental and food skin testing completion rates (91% and 92% in 2019 vs 60% and 64% in 2020, respectively, P < .001). Drug allergy testing completed after internal referral remained low but comparable (51% in 2019 vs 52% in 2020). Transitioning nonprocedural visits to video allowed allergen immunotherapy and biologic injection visits to resume at a volume similar to pre-COVID. No COVID-19 infections resulted from in-clinic exposure. CONCLUSIONS: Although transitioning to TM-based care allowed continued A/I care delivery, strategies are needed to achieve higher testing completion rates and ensure video visits do not exacerbate existing health disparities.

Background Electronic consultations (e-consults) are asynchronous clinician to clinician exchanges within the electronic health record (EHR). Objective We sought to demonstrate the utility of e-consults in allergy/immunology (A/I) inpatient consultations. Methods Inpatients ≥ 18 years of age for whom an A/I consultation was requested were eligible for an e-consult. An e-consult was completed if considered appropriate by the A/I physician with recommendations made in the EHR. In-person consultation was performed for inpatients if deemed necessary. Likert scale satisfaction data was collected from requesting providers after the e-consultation. Cost was calculated using time-based billing codes plus the cost of penicillin allergy evaluation, if appropriate. Results Of the 109 inpatient consults, 78 (71.6%) were completed through an e-consult, and 31 (28.4%) were completed by an in-person consult. The most common indication for inpatient consult was evaluation of penicillin allergy in 73 (67%) patients. The most common reason to complete an in-person consult was the need to complete penicillin skin testing in 17 of the 31 (55%) patients. E-consults were completed in less time than in-person consults (15 minutes [IQR: 10 to 15], versus 60 minutes [IQR: 45 to 60], p < 0.001 and had a shorter turnaround time (1 hour [IQR: 0.5 to 2], versus 7 hours [IQR: 3 to 19], p < 0.001. Management recommendations were followed at a similar rate regardless of type of consult (88% of e-consults versus 96% of in-person consults, p=0.162). 97% of requesting providers reported an “excellent” or “good” impression of e-consults. E-consults were less costly than in-person consults. Conclusions E-consults have utility in providing inpatient allergy/immunology consultation, and may have advantages over in-person evaluation, while adequately maintaining provider satisfaction., Highlights Box 1. What is already known about this topic? There is outpatient data for e-consults in A/I, but no data for inpatient A/I consultations. 2. What does this article add to our knowledge? We demonstrate that A/I inpatient e-consults are feasible, potentially less costly, and maintain requesting provider satisfaction for certain conditions. 3. How does this study impact current management guidelines? E-consults are a strategy to improve A/I access in inpatient settings and are particularly relevant during the COVID-19 pandemic.