BT17 Patient Assessment Wrap-up Session: the utility of consensus decision-making in teledermatology

Abstract

Abstract In our unit, skin cancer referrals are triaged via teledermatology following high-quality image capture of lesions, including dermoscopic views. Patients are discharged, invited for a face-to-face assessment or listed directly for surgery. Remote and asynchronous consultations are at odds with the traditional clinical training all our consultants underwent, and therefore introduce new uncertainty into our work. As a way to maximize remote discharges, and improve the consistency of and the confidence in our own teledermatology diagnoses, we developed Patient Assessment Wrap-up Session (PAWS). This is an email-based discussion group allowing consensus decision-making on cases with lesions that demonstrate some ambiguity and that individually we would usually bring to a face-to-face appointment. Between March and April 2022, a total of 566 teledermatology cases were allocated to five consultants within the department. In total, 476 (84.1%) were dealt with independently by the allocated consultant. The remaining 90 cases (15.9%) were discussed via PAWS, with 48 (53%) being discharged as a result. On average, four clinicians responded to the PAWS request, and the average time to reach a consensus was 14 h. Of those discharged, two were re-referred within 6 months, one for different lesions and one for the same noncancerous lesion; however, both were discharged again. The additional discharges led to 16 h of clinic time saved, but the PAWS time cost between 12 and 18 h. Although PAWS is currently probably consultant-time neutral, the timing is more flexible than a face-to-face clinic. Additional advantages have also become apparent while using the process. It aids continued professional development and peer assessment while simultaneously providing a service. The patients discharged after PAWS are also saved from a fossil fuel burning visit to the hospital and having to take time off work, and so on. The PAWS also allows for junior colleagues to leverage support from more experienced clinicians when balancing risk and dealing with difficult decision-making. We would like to share our PAWS process as it may also benefit other services using teledermatology.