Use of a hybrid teledermatology model in an Australian tertiary hospital during the COVID-19 pandemic

Abstract

To the Editor: The COVID-19 pandemic has led to the adoption of teledermatology by health services across the world. There is increasing support for the use of teledermatology in the outpatient setting; however, its role in inpatient and emergency settings is less established. We reported the use of teledermatology in inpatient and emergency settings at the Dermatology Department, St George Hospital, a tertiary center in Sydney, Australia. Inpatient and emergency consultations are conducted at our institution by 1 of 2 staff dermatologists per day and 1 hospital-based dermatology resident. A hybrid model of inpatient teledermatology consultations was established prior to the COVID-19 pandemic. All referrals would be seen face to face by the dermatology resident to ensure relevant history, and high-quality clinical and dermatoscopic photographs would be taken. The referrals would then be summarized and sent to the on-call dermatologist, who would provide an impression and plan for the resident to enact. For severe or life-threatening cases, the on-call dermatologist would also attend the face-to-face consultation. This system involved both synchronous and asynchronous models depending on the triaging of consultations performed by the dermatology resident. To avoid the exposure of the on-call dermatologists to COVID-19, which would subsequently shut down the provision of dermatology services to both outpatient and inpatient or emergency services, this hybrid model of inpatient teledermatology was maintained during the pandemic, and outpatient clinics were converted to teledermatology for large proportions of 2020 and 2021. Using this hybrid approach, our dermatology service avoided any shut down periods due to the exposure of the 2 on-call dermatologists to COVID-19. The main exposure site for COVID-19 was the emergency department, and this was the main source of inpatient referrals (Fig 1). There was no statistically significant difference (P > 0.05, Student t test) in the number of inpatient consultations seen between pre-COVID-19 2019 (n = 295; mean, 27 consultations per month; SD, 10.9) and 2020 (n = 305; mean, 25 consultations per month; SD, 6.3) or 2021 (n = 323; mean, 27 consultations per month; SD, 8.1).1Ho G. Blake S.C. Sheriff T. Daniel B.S. Murrell D.F. Impact of COVID-19 on inpatient dermatology consults in an Australian tertiary hospital.Australas J Dermatol. 2021; 62: 427-428Crossref PubMed Scopus (3) Google Scholar This may have been due to the establishment of the hybrid model of inpatient teledermatology. In 2021, 70% of inpatient consultations had a treatment plan provided to the referring team within the same day of referral. The role of teledermatology to increase the efficiency of inpatient consultations was described prior to the COVID-19 pandemic, with reduction in the time taken for inpatient medical teams to receive advice from dermatology consultants.2Sharma P. Kovarik C.L. Lipoff J.B. Teledermatology as a means to improve access to inpatient dermatology care.J Telemed Telecare. 2016; 22: 304-310Crossref PubMed Scopus (25) Google Scholar Concordance in investigations and treatment plans between teleconsultations and face-to-face consultations has also been described.3Keller J.J. Johnson J.P. Latour E. Inpatient teledermatology: diagnostic and therapeutic concordance among a hospitalist, dermatologist and teledermatologist using store-and-forward teledermatology.J Am Acad Dermatol. 2020; 82: 1262-1267Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar,4Gabel C.K. Nguyen E. Karmouta R. Liu K.J. Zhou G. Alloo A. Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease.J Am Acad Dermatol. 2021; 84: 1547-1553Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar The COVID-19 pandemic has seen wider adoption of teledermatology services.5Loh C.H. Tam S.Y. Oh C.C. Teledermatology in the COVID-19 pandemic: a systematic review.JAAD Int. 2021; 5: 54-64Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar The experience of our department supports the use of teledermatology for efficient delivery of care that has been stable throughout the COVID-19 pandemic. Our experience supports use of a hybrid model of teledermatology rather than a virtual model and can be applied in other parts of the world. None disclosed.