BT22 The concordance between dermatology doctors in their approach to teledermatology referrals

Abstract

Abstract Telemedicine is an innovative, rapidly evolving method of care delivery in the National Health Service. The main long-term benefit of teledermatology triage is to ensure that patients receive timely care in the most appropriate setting, and to increase capacity in secondary care for patients who need face-to-face referrals. However, the diagnosis made and the advice given may vary depending on the experience and knowledge of the person triaging. The aim of this study was to evaluate how the interpretation of the information/images by different clinicians can affect the outcome of a teledermatology referral. The data collected in this project are expected to provide knowledge about the concordance between dermatology doctors in their approach to teledermatology referrals and to evaluate the impact on quality of care. The teledermatology service referrals to our dermatology department are made through the national electronic Referral Service, with the option to attach images or to refer patients to an image-taking clinic based at the hospital. Dermatology consultants will then review referrals virtually, relaying advice back to the referrer. We provided a mixture of 10 teledermatology referrals who had attended the image-taking clinic to dermatology consultants and dermatology trainees. The dermatology doctors were asked to complete an outcome template for each referral based on the information/images provided. The study was completed by nine consultants and four trainees. Only three consultants (33%) and no trainees had previous experience of the teledermatology service. The respondents evaluated the clinical information provided in the referrals as good (41%), satisfactory (47%) and poor (12%). The clinicians evaluated the quality of images taken following the referral as good (68%), satisfactory (28%) and poor (4%). Overall, 90% of the consultants and 72% of the trainees agreed with the final diagnosis/outcome of the teledermatology referral. The benign skin lesions had the least consistency between the clinicians in terms of the diagnosis and type of the follow-up arranged. The follow-ups arranged after a referral included routine referral to clinic (consultants 30%, trainees 32%), urgent referral to clinic (consultants 25%, trainees 40%), referral to clinic if not improved (consultants 21%, trainees 17%) and discharge (consultants 23%, trainees 10%). In conclusion, there was satisfactory concordance between clinicians in responding to the majority of the teledermatology referrals. Trainees have shown to agree with the final diagnosis in the majority of cases; however, they still need more training in this area, particularly on how to gain confidence in arranging an appropriate follow-up plan after the advice given.