PD14 Audit of urgent phototherapy referrals

Abstract

Abstract The British Association of Dermatologists’ (BAD) phototherapy guidelines state that patients referred urgently for phototherapy should start treatment within 3 weeks of referral and that if the patient is considered to require treatment urgently, then it should be started as soon as possible, to reduce patient discomfort and avoid the need for hospital admission. The prepandemic waiting time for urgent referrals, according to an audit in March 2021, was 6 weeks, but this time was even longer postpandemic. During the COVID-19 pandemic lockdown, the phototherapy service was suspended and then resumed in reduced capacity in our unit. The pandemic is also likely to have affected disease severity and patient’s concerns about treatment with systemic options. Our audit objective was to identify the time taken between referral to treatment start time for urgent referrals. Secondary objectives were to identify whether there was any prevalence of certain disease categories in deciding upon urgent referrals, and to identify if severity assessment scores were checked prior to urgent referrals by referring clinicians as per local guidelines. The audit was conducted retrospectively by including all urgent phototherapy referrals for 6 months between January and June 2022. Sixty-four urgent referral forms were analysed. The time taken between referral to treatment start time was 12 months. The majority of the urgent referrals (73%) were for eczema, 16% for psoriasis and 5% for mycosis fungoides. Other conditions such as polymorphic light eruptions, lichen planus and macular amyloidosis totalled 6% of referrals. Only 26% of referrals had documented disease severity scores. Thirty per cent of the referrals were < 18 years of age; young adults (19–25 years) accounted for 19% of referrals. Time taken between referral to treatment start time was 12 months, which significantly exceeded BAD standards. A number of factors affected this, including the impact of the COVID-19 lockdown on services and treatment capacity, patient choices and escalation of disease severity in lockdown, increased referrals with severe skin disease, preference in certain age groups such as children, and psychosocial factors. Patients with severe skin disease needing urgent treatment should be carefully triaged to receive treatment urgently, to avoid admission. Clinicians should assess this appropriately on a case-by-case basis and document disease severity scores and impact of skin disease in all urgent referrals.