The landscape of healthcare is rapidly evolving, and virtual care is becoming an integral part of modern medical practice. Dr. Shirley Lee, a renowned physician advisor at the Canadian Medical Protective Association, recently delivered a captivating lecture on the medicolegal considerations for virtual care and hallway consults. Hosted by Virtual Hallway in a hybrid format, both in person and online, the session sparked engaging discussions and raised thought-provoking questions.
Dr. Lee highlighted several key points during her talk:
Dr. Lee's insightful lecture not only provided valuable guidance for healthcare professionals navigating the world of virtual care but also sparked essential conversations on the topic. As a follow-up, Dr. Lee will be providing resources and articles that will be uploaded to the Virtual Hallway portal for further exploration.
Stay tuned for more updates on this crucial aspect of modern healthcare, and be sure not to miss future lectures and events hosted by the Virtual Hallway platform.
To view Dr. Lee’s lecture please login to your account under the Lectures Tab.
Coming up will be Dr. Phil Tibbo’s lecture on Management of Early Psychosis and Schizophrenia, date to be announced soon!
In this short guide, you’ll learn how to setup your:
✅ Profile
✅ Account settings
✅ Availability
Your profile helps colleagues identify and connect to you as a person and helps ensure that you receive consult requests right in your wheelhouse.
✅ Upload a profile picture
Specialists with profile pictures get around 3x the consult requests. How to upload a profile picture...
✅ Update your bio
Write in the 1st person and keep it brief to help colleagues understand your background and training. If you have specific areas of interest or subspecialty training, include that here. How to add a bio to your profile...
Account settings allow you to personalize notifications, calendar sync, security and auto-fax options.
✅ Email and Text Notifications
Never miss a consult with automated email and text notifications. Learn more about how to make notification work for you.
Do you use a centralized calendar? If so, subscribe to your Virtual Hallway calendar to get your consults to appear in your calendar. Learn more about how to subscribe to your calendar.
We recommend using a strong password and enabling two factor authentication (2FA). Learn more about how how to reset your password and enable 2FA.
When you complete a consult report, opt into our auto-fax feature to have all information automatically faxed to your office staff. Learn more about how to set up auto fax.
Setting recurring availability that fits your regular schedule is an easy, “set-and-forget” way to provide sustainable access to primary care providers. You can also set availability on individual dates and times. Learn more about times that work well for phone consultations.
By opting into OnDemand booking, requesting physician can indicate they are open to receiving a call from you anytime prior to your scheduled consult. This popular feature gives you the freedom to take advantage of any window of time you have to complete a consult ahead of time. Learn more about this feature.
You can customize how much “buffer” time you require between when a consult is requested and the earliest it can be scheduled for. You can also customize the amount of time that a phone consult is booked for. Learn more about how to adjust your advance notice and consult duration settings.
Answering consult questions is a fundamental aspect of specialty medicine. However, specialists see patients of their own and often want to run patient cases by other physicians. Similar to other healthcare providers, specialists face the same barriers to connecting with colleagues - endless phone tag, misaligned schedules, and challenging documentation requirements.
Solution: Virtual Hallway Specialist to Specialist phone consultations.
Specialists can consult with any other specialist on the platform. They can consult within their own or different specialty areas, as there are countless reasons specialists might want to consult.
Here’s a few...
In the status quo, if a specialist is unsure about a course of action, they have to either (a) make a decision outside their comfort zone on a patient’s care; or (b) send a formal referral leading to a multi-month wait for the patient. Now, specialists can now get their questions answered by a local expert just like primary care providers.
To book a consult simply select a specialist to consult with, select a date and time then enter brief patient details.
Pick up with questions, hang up with answers.
Primary care providers (PCPs) play an increasingly large role in the diagnosis and management of mental and behavioral health conditions. Often times, a quick and collaborative discussion between the PCP and a local psychiatrist is enough to optimize a patient's care plan within the primary care setting.
We often get queries about which types of questions make good psychiatry consult requests. We asked a Virtual Hallway psychiatrist for their most commonly received, yet effective, consult questions.
Patient’s symptoms don’t always point to an obvious diagnosis. Often, it takes a historical review, physical examination and investigation to figure out what might be going on. Consulting with a psychiatrist during this process can help narrow the diagnostic possibilities and aid in formulating a plan for the next steps in a patient’s care.
Often times, PCPs manage notably complex patient cases with little, or no, psychiatry support. Virtual Hallway consults with a psychiatrist can aid in educating a patient on their condition, as well as understanding how to approach care and select the best models of delivery.
Psychotropic medications are one of most complex sets of medications to prescribe. Phone consults with a psychiatrist are a great way to clarify and confirm dosages, combination strategies and discuss second/third line options.
When a patient is referred for an in-person psychiatric assessment, they will most likely face a long wait (a year or more in some cases). Managing a patient's condition as they wait is critical to their care - Virtual Hallway consults enable access to specialist input on emerging or ongoing challenges. In some cases, specialist advice is enough to optimize the care plan and their in-person appointment may no longer be required.
Many Virtual Hallway consults are simply to review, discuss and provide confirmation by a psychiatrist that the existing care plan is reasonable given the patient’s presentation. A second opinion only takes 10 minutes, instilling confidence and confirmation on the best path forward.
“Can I get your thoughts on this?”
“Can I run something by you?”
These are familiar questions asked by primary care providers to specialists. Questions like these are part of the daily discourse of medicine, coined hallway consults.
Let’s take a look back
Traditionally, hallway consults occurred in elevators, lunch rooms or hospital corridors (earning their name). These brief clinical interactions were localized, casual, undocumented and aimed at solving a particular question on the spot. Such interactions relied on chance encounters with a colleague – bumping into someone or finding shared free time – an unreliable method for gaining advice. Given that Canada is geographically vast and not densely populated in some areas, oftentimes there are few or no specialist colleagues to consult with.
Entering the digital era, hallway consults have shifted to take place by way of email, phone or video. In turn, reducing the traditional reliance on chance encounters with a colleague. These new means of connecting have caused a shift in how we consult, increasing access to specialists both in and outside of one’s institution.
Hallways are not what they used to be.
Current day, how do we connect and gain advice on patient care?
Both traditional and digital consults are tried-and-true methods for gaining advice from a specialist, though they are plagued with challenges.
We haven't reinvented the wheel; we’ve just made it better. Like a traditional hallway consult, after a few minutes of collegial discussion you can confidently deliver the highest quality of care based on actionable advice.
It’s a hallway consult, several a day are a-ok.
Streamlined and simple – book, consult via phone, receive report, receive payment.
Virtual Hallway doesn’t take time away from you, it gives it back.
…to teach them this Art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples …
Hippocrates
Being a specialist on Virtual Hallway means you are now part of a solution to efficiently provide rapid, effective care to hundreds of thousands of patients who would otherwise be without specialist care, or sit for months on waitlists.
Joining Virtual Hallway means now being part of a community where family physicians and specialists can work together in real time for the best of large numbers of patients.
The first step is to log into your calendar and block off times where family physicians and nurse practitioners can book phone consults with you. You can choose as much or as little time as you’d like. There are some strategies to consider to maximize the number of consults you receive. It takes a bit of time to really build up a big consult base, but with sticking to the basic principles it will happen.
It’ll come by text message and email. Make note of it, review the consult within your portal and ensure that it is a request that will work for a phone consult.
At the time of the scheduled request, call the family physician. Discuss the case, ask lots of questions, get a sense of the family doctor’s impression of the problem. Come up with a plan together.
Write up the call in the consult report form. It can be as short or as long as you wish, though we recommend you include a brief summary include any suggestions made. Record the provisional diagnosis and submit the report.
After you submit your consult report, we will bill provincial phone consult codes on your behalf. Then, once a month we will transfer you your billings along with a statement.
Your consult request form is customizable. This form can ask family physicians to include as much or as little information as you would like to have. Some specialists would like to have a lot of information up front in the consult request form so that they can focus on recommendations during the call. Other specialists prefer to have a more basic form because they want the conversation to be more free flowing. It is up to you.
Duty of Care
The division of care within Virtual Hallway is clear: the Specialist is providing advice to the family physician based on the information provided in the consult request form and the call. However, the family physician is aware that the Specialist is not taking over care of the patient. Virtual Hallway is just that, a hallway consult. Except it can be done anywhere. And is documented. And reimbursed.
Reconsults
Family physicians can re-consult on patients with the same specialist. It is recommended that this not be done more frequently than 14 days because some jurisdictions do not permit billing more frequently for a given patient Than 14 days. However, reconsults can be an excellent way to ensure some continuity of care and follow up on recommendations made.
Office staff
Virtual Hallway accounts can be converted to Practice Group accounts. These accounts allow for a physicians office staff to access documentation for imporatation to EMRs, complete consult request forms, or complete consult reports.
Practitioners on Virtual Hallway spend a lot of time thinking how best to help their patients. We often get queries about what types of problems make a good consult request. Having effective consult requests can streamline the entire consultation process, allowing more quality time spent problem solving through the patient’s problem.
So what are some examples of effective consult requests? We’ve gathered a few tips examples and tips from Virtual Hallway General Internists:
Often labs come back abnormal, but the direction to go next is unclear. This is a common and effective use of phone consultation. Consulting on this can lead to a faster diagnosis, avoid unnecessary tests and in some cases, reassure patients.
CHF is a complex problem, and made even more complex as individuals with CHF typically have multiple other medical problems that might be exacerbated by some medications. This type of problem is a excellent example of where consultation can help optimize a patients treatment.
Whether it be for atrial fibrillation or venous thromboembolism, stopping, starting and titrating anticoagulants can be tricky. This is where talking through matters with an Internist can help make this process as efficient as possible.
Patient’s symptoms don’t always lead to an obvious diagnosis. Often, it takes a lot of history taking, physical exam and investigation to figure out what might be going on. Consulting with a General Internist during this process can help narrow the diagnostic possibilities down, and also help in selecting the investigations with the highest yield for a patient’s presenting problems.
Making a diagnosis is part one. Choosing the best treatment is step two. Working through the treatment options for a patient’s diagnosis is an excellent exercise to do with a General Internist.
While these are some examples of situations where consultation is appropriate, there are no hard and fast rules about consulting. A consult should be an option whenever there is uncertainty about a patient’s condition. Two heads are better than one.
