Patterns of inpatient dermatology referral and predictors of diagnostic accuracy in non-dermatologists in a Northern District hospital in Singapore.

Abstract

A wide range of dermatological conditions is often encountered in the inpatient setting. Many non-dermatologists experience difficulty in their diagnosis, and referral to a dermatologist is often warranted. In our local setting, this is made through a formal written referral letter, which is usually drafted by the junior doctor on the team. This study was conducted to characterize patterns of inpatient dermatology referral and to investigate whether predictors of diagnostic concordance between the referring non-dermatologist and the reviewing dermatologist can be identified. A total of 168 inpatient dermatology referrals made between June and September 2013 at a Northern District hospital in Singapore were identified and reviewed. Collated variables were broadly divided into: (i) patient demographic details; (ii) the referring details of non-dermatologists; and (iii) the response details of reviewing dermatologists. No predictors of diagnostic concordance could be identified statistically. A total of 90.5% (n=152) of referrals were made for both diagnostic and management purposes, whereas 9.5% (n=16) of referrals were made purely for management purposes. Of the 152 diagnostic and management referrals, a preliminary diagnosis was reflected in 69.1% (n=105). In 47.6% of all referrals (n=80), more than one dermatological condition was identified. The fungal smear was the most commonly requested ancillary investigation (22.6%, n=38/168). Cutaneous skin infections (32.0%, n=85/266) and endogenous eczema (32.0%, n=85/266) were by far the two most commonly identified dermatological conditions in our local cohort of patients. The need for a dedicated inpatient dermatology service is reinforced. However, targeted education may be employed to facilitate the referral process.