BT04 Efficient triaging of advice and guidance referrals using teledermatology via the National Health Service Electronic Referral System platform: reporting positive outcomes from the COVID-19 era

Abstract

Abstract The provision of teledermatology in National Health Service (NHS) practice has increased markedly over the last decade. The e-Referral System advice and guidance (A&G) is a platform through which teledermatology services can be provided. It was first implemented in our university teaching hospital department in 2016, but extensive use of this system started during the COVID-19 pandemic. Recognizing the practicality of A&G’s ongoing use to triage referrals efficiently, it was made compulsory for all routine referrals to our department in January 2021. We report on A&G triage use on health service outcomes over a 4-year period (June 2019–June 2022). Retrospective analysis of datasets from four timepoints was chosen for comparison: the month of June in 2019, 2020, 2021 and 2022. The main outcomes analysed were total number of A&G requests, number converted to referral, number returned with advice, percentage of discharges at first attendance and referral to treatment (RTT) waiting time performance (defined as percentage of referrals seen in < 18 weeks). The A&G requests increased appreciably over the study period; only 45 requests received in June 2019, increasing to 965 in June 2020 and 1384 in June 2021, and remaining stable (n = 1140) by June 2022. The initial rise was attributable to the COVID-19 pandemic; further increases were due to changing referral pathways. The majority of A&G requests were returned with advice (77.6%, 66.4% and 54.5% in June 2019, 2020 and 2021, respectively), except in June 2022 where 52.2% were converted to referrals. Separate to quantitative analysis, subjective reporting from triaging dermatologists noted improved primary care referral quality (user descriptions, differential diagnoses suggested and treatment options considered), implying educational benefits for referrers, gained from timely and targeted feedback. This was supported by an increasing conversion-to-referral percentage over the period. Triage of referrals allowed the identification of patients requiring advice prior to clinic review, resulting in improved use of clinics. Subsequently, the percentage of referrals discharged after the first clinical encounter decreased from 70% (June 2019) to 29.9% (June 2020), remaining low by June 2022 (37.9%). Concordantly, RTT performance increased from 60.3% in June 2020 to 88.2% 2 years later. The use of A&G to triage all routine referrals has positively impacted on our department’s health service outcomes, noticeably reducing discharges at first attendance and improving RTT performance. We report on these successful outcomes to highlight to other NHS dermatology teams about efficient methods of teledermatology work in an NHS undergoing ever-increasing demands.