Inpatient Dermatology Research Articles

Assessment of an inpatient dermatology service line in the rural United States.

Assessment of an inpatient dermatology service line in the rural United States.

51089 A critical assessment of inpatient dermatology service line in the rural United States

51089 A critical assessment of inpatient dermatology service line in the rural United States

51209 Utilization of a Formalized Manual to Improve Residents’ Comfort Level with Inpatient Dermatology Consultations

51209 Utilization of a Formalized Manual to Improve Residents’ Comfort Level with Inpatient Dermatology Consultations

Spectrum of Inpatient Pediatric Dermatology Cases at a Tertiary Health Care Centre in South India.

Background Dermatologists and pediatricians commonly encounter pediatric dermatology cases in their clinical practice, and the number has risen for the past decade. While numerous studies have addressed adult inpatient dermatology cases, there is a lack of data on the same for the pediatric population. Aim The study aimed to investigate the spectrum and outcomes of inpatient pediatric dermatology cases at a tertiary health care center. Methods This was a hospital-based, cross-sectional study that included children under the age of 16 years with primary skin disorders who were admitted to the pediatric dermatology unit. Patients were categorized into six groups based on their provisional diagnosis for better analysis. Results A total of 105 children were admitted, with a male-to-female ratio of 1.2:1. The average age of admitted children was 5.8 years, with the majority belonging to the school-going age group, accounting for 44% of the patients. Conclusion Inflammatory skin conditions like childhood psoriasis and erythroderma were the most common group of disorders presented to us, followed by hereditary conditions like keratinization disorders and mechanobullous disorders. Pediatric dermatology emergencies (PDEs) require an inter-professional approach for timely intervention and management.

Trends in Inpatient Dermatology and The Impact of the COVID-19 Pandemic at A Tertiary Care Facility in Western India

Background: Little is known regarding the effect of the coronavirus pandemic on the characteristics of dermatology admissions, particularly in the Indian context. Objectives: To conduct a retrospective analysis of the discharge records of all patients admitted to a tertiary care centre in Western India from 1 January 2019 to 31 December 2022. Methods: Patient records were reviewed and compiled. Diagnoses were grouped to achieve consistency with international studies. Finally, the effect of COVID on admissions was determined. Data samples were assessed using descriptive statistics. Continuous variables were expressed as median or mean. The student’s t-test and chi-square test were utilised to investigate wherever appropriate. Results: Inpatient care was required for 1,817 patients. Males (1000, 55.04%) were significantly more likely to be admitted than females (817, 44.96%). The leading causes of hospitalisation were bacterial infections (26.42%), vesiculobullous disorders (17.45%), and psoriasiform disorders (11.34%). The greatest number of admissions occurred in 2019, followed by a substantial decline in 2020. Admission rates for vesiculobullous disorders, psoriasiform disorders, and malignancies were significantly higher during the pandemic period. Conclusions: Our study offers an analysis of the impact of the coronavirus pandemic on the patient profiles of patients admitted to a dermatology ward.

BT35 Quality improvement project: modernizing the inpatient dermatology handover

BT35 Quality improvement project: modernizing the inpatient dermatology handover

A Critical Assessment of Inpatient Dermatology Service Line in the Rural United States

Objective: We sought to classify dermatologic conditions presenting in rural inpatient hospitalization. Methods: Retrospective chart review. Conclusion: Limited rural dermatology care in the United States prompted the establishment of an inpatient dermatology consult line in rural Upstate New York. Over 3 years, 27.7% of consults were admitted for dermatologic concerns, 21.5% for both dermatologic and medical issues and, 50% for non-dermatologic reasons but later seen by dermatologists. Common conditions included eczematous rashes, infections, drug reactions, edematous skin conditions, and autoimmune diseases. Among patients admitted for dermatologic concerns, cellulitis (3) and rashes (3) were the most common. Interestingly, 74% of provisional dermatologic diagnoses matched final diagnoses before further workups. Approximately 58.5% of consults were deemed highly valuable. Followup showed 73.8% improvement, 23.1% deceased from different pathologies, and 3.1% stable. Understanding the rural dermatology landscape could enhance access, diagnostic accuracy, and the feasibility of inpatient consult services. Understanding the rural dermatology landscape may improve access to specialist care, increase diagnostic accuracy, reduce disease burden and associated costs, and communicate the feasibility of inpatient consult services either in-house or via teledermatology to rural hospital systems.

Acute Interstitial Inflammation on Skin Biopsies and Positive Tissue Cultures in Cellulitis Patients Are Associated a Worse Prognosis.

Cellulitis is a significant public health burden and lacks a gold standard for diagnosis. Up to 1/3 of patients are incorrectly diagnosed. The skin biopsy has been proposed as the gold standard. In this study, we evaluate the histopathologic characteristics and tissue culture positivity of biopsies in patients diagnosed with cellulitis seen by our inpatient dermatology consultation service. This retrospective cohort study examined patients who were hospitalized with a skin and soft tissue infection at our institution between 2011 and 2020 and underwent a skin biopsy. Those with a positive tissue culture were more likely to die within 30 days compared with those with negative tissue cultures (26% vs. 6%, P = 0.048). Patients who died within 30 days were more likely to have acute interstitial inflammation as a feature on histopathology (38%, P = 0.03). Single institutional design, unintentional exclusion of patients with organism-specific diagnosis, and selection for a medically complex patient population because of the nonroutine collection of biopsies. Positive tissue cultures and histopathology showing acute interstitial space inflammation on skin and soft tissue infection (SSTI) biopsies are associated with increased mortality and thus may serve as indicators of poor prognosis.

The United States dermatology inpatient workforce between 2013 and 2019: a Medicare analysis reveals contraction of the workforce and vast access deserts—a cross-sectional analysis

While time spent practicing inpatient dermatology has decreased since the 1990s, less is known about the current state of inpatient dermatology. We describe the distribution and frequency of inpatient dermatology encounters servicing the United States Medicare population between 2013 and 2019. Cross-sectional analysis of publicly available inpatient Medicare Part B claims data from 2013 to 2019 was conducted. Main outcomes and measures were characteristics and trends of dermatologists performing inpatient encounters. Categorical variables were compared using χ2 analysis. Trends were analyzed for linearity using Pearson correlation coefficient. 782 physicians met inclusion criteria for inclusion. Dermatologists were more often male (56.5%), possessing allopathic Medical Doctorate (MD) (86.3%), and in metropolitan settings (98.2%). However, proportion of female inpatient dermatologists increased significantly (37.9% to 46.2%). Across rural and metropolitan practices, number of inpatient physicians (2013: 356; 2019: 281) and number of medical centers in which dermatology encounters occurred (2013: 239; 2019: 157) decreased, more significantly in non-residency-associated institutions. Spatial analysis revealed wide regions lacking dermatologists meeting defined criteria. Limitations included the need for ten Medicare inpatient encounters for inclusion, counties without reported data. In conclusion, the number of dermatologists performing > 10 inpatient encounters per year is decreasing, and large variations exist in the number of U.S. inpatient dermatology visits.

Retrospective Analysis of Inpatient Dermatologic Consultations in a Residency Training Program

Objective: This study assessed the prevalence and clinical characteristics of inpatient dermatologic diseases, examined trends over 3 academic years in a tertiary care hospital in Thailand, and evaluated their relevance to the current dermatology residency curriculum. Materials and Methods: A retrospective review was performed at the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Consultation records from July 2018 to June 2021 were assessed. Data extracted included patient age, sex, referring departments, and diagnoses. Results: Of the 1964 consultations, 2002 diagnoses were identified. Consistent with previous findings, the predominant diagnostic categories were drug eruptions (28.02%; 561), eczema (16.18%; 324), and viral infections (9.29%; 186). Internal medicine made the most requests, followed by surgery and orthopedics. While the prevalence of consulted diseases remained constant over the 3 academic years, the total number of consultations increased. Most of the consulted conditions were already covered in the “must-know” section of the dermatology residency curriculum, with a few exceptions. The consultation cases satisfied the inpatient evaluation requirements of EntrustableProfessional Activity. Conclusion: The prevalence of inpatient dermatologic diseases was highest for drug eruptions, followed by eczema and viral infections. The consistent trend in the prevalence of these consulted diseases underscores the significance of inpatient dermatology. Incorporating these insights into revisions of the dermatology residency curriculum may enhance the training of dermatologists.

Pediatric consultative dermatology: A survey of the Society for Pediatric Dermatology workforce reveals shortcomings in existing practice models of pediatric dermatology consult services in the United States.

The rate of pediatric hospitalization for cutaneous pathology has been increasing in recent years, often requiring the expertise of consulting pediatric dermatologists; however, the infrastructure of inpatient pediatric dermatology consultative services remains poorly characterized. We sought to assess the structure, consult volume, physician compensation, and utilization of teledermatology in pediatric dermatology inpatient services to better understand the current care model. Our survey of 118 pediatric dermatologists revealed that 89% of respondents see between 1 and 10 new consults per week, 39% perform all inpatient consults including evening and weekends without assistance from other providers, 71% do not have protected time during the week to provide inpatient consultations, and only 10% receive financial compensation via stipend. By highlighting both the high demand for pediatric consultative dermatology as well as the significant burden placed on these providers by existing practice models, we hope to encourage a reappraisal of the current infrastructure of pediatric inpatient dermatology to increase structural and financial support for this vital service.

Inpatient Dermatology: A Reterospective Analysis of Admitted Patients in Dermatology Department Services Hospital, Lahore

Inpatient Dermatology: A Reterospective Analysis of Admitted Patients in Dermatology Department Services Hospital, Lahore

Document by example: resident perception of SmartPhrases for inpatient dermatology consultations.

Document by example: resident perception of SmartPhrases for inpatient dermatology consultations.

42757 Inpatient dermatology consultations in patients with connective tissue diseases

42757 Inpatient dermatology consultations in patients with connective tissue diseases

Quantitative Benefit of Inpatient Dermatology Services on Hospital Length of Stay in an Academic Hospital.

Dermatologic disease has been shown to have high rates of diagnostic and treatment discordance between dermatologists and non-specialists. Inpatient dermatology consultative services have the potential to improve patient care, but there is a paucity of data evaluating the quantitative effects of such services. This study aimed to evaluate the impact a newly established inpatient dermatology service had on quantitative patient care outcomes. This retrospective cohort study compared quantitative care measures of dermatologic inpatients during the years both pre- and post-implementation of an academic hospital's dermatology consultative service. The primary outcomes included hospitalization duration, readmission rates, and establishment of outpatient dermatologic care. The study found a 1.04-day reduction in hospital length of stay (p-value = 0.046) after the consultation service establishment. Additionally, there was a significant increase in the rate by which patients sought outpatient dermatology follow-up (6.7% versus 24.4%, p-value <0.001). No significant change in the all-cause readmission rate was identified. The reduction of hospitalization duration supports inpatient dermatology services as a viable means to provide improved patient care and reduce health systems costs. Hospitals that do not have a consulting service for cutaneous conditions provided by a dermatology specialist should strongly consider establishing such a department.

Psychiatric comorbidities on an inpatient dermatology consultation service: A cross-sectional analysis.

Despite the high prevalence of psychiatric illness in hospitalised dermatology patients, characterisation of psychiatric comorbidities on an inpatient dermatology consultation service in the United States has yet to be performed. To fill this gap in knowledge, we investigated the prevalence of and factors associated with psychiatric illness on the inpatient dermatology consultation service at the University of Southern California. Of the 429 patients seen by the dermatology consultation service between June 2021 to July 2022, 147 (34%) had psychiatric illness (defined as having at least 1 psychiatric diagnosis). Increasing age was associated with a decreased likelihood of psychiatric illness, while housing instability, chronic dermatologic disease, drug reaction, and pruritus without rash were associated with an increased likelihood of psychiatric illness. The high prevalence of psychiatric illness observed in hospitalised dermatology patients emphasises the importance of collaboration between consultant dermatologists and mental health specialists, particularly when specific sociodemographic or disease factors are present.

Palliative Care: Utilization Patterns in Inpatient Dermatology.

Palliative care (PC) focuses on improving the quality of life of patients with serious illnesses. The use of PC in the field of dermatology is limited despite the presence of severe disease. In this cross-sectional study of inpatient dermatology consultations, we aimed to evaluate PC utilization among patients hospitalized with select severe dermatologic diseases. Our results suggest that PC may be underutilized when caring for patients with serious skin diseases. Palliative care should be an integral part of caring for patients with serious illnesses, and further research characterizing ways this can be accomplished by dermatologists is needed.

A national survey comparing practice patterns and residency training satisfaction for categorical dermatology versus combined internal medicine and dermatology trained physicians.

Combined internal medicine and dermatology (med-derm) training programs were created to advance complex medical dermatology and inpatient dermatology care. A prior study demonstrated that compared to categorical dermatology residents, med-derm residents had less program satisfaction, yet indicated a stronger desire to pursue careers in academia. No follow-up data on practice patterns after training has been reported. We aimed to characterize differences in residency program satisfaction and practice patterns between physicians trained in categorical dermatology compared to med-derm residency programs. We surveyed physicians who graduated from combined med-derm programs along with their counterparts, from six institutions, that either currently or historically had a combined med-derm training, from 2008-2017. Fifty-five percent of med-derm and forty-one percent of categorical-trained physicians responded. The practice patterns between the two groups were similar. A quarter of med-derm physicians continued to provide general internal medicine services. Categorical trained physicians were significantly more satisfied with their training (P=0.03) and performed more excisions on the head/neck (P=0.02). The combined graduates had significantly greater confidence in multidisciplinary care (P=0.003), prescribed more biologic (P&lt;0.001) and non-biologic immunosuppressive agents (P=0.002), and volunteered more for the underserved patients in their communities (P=0.04). Although few differences in overall practice patterns between categorical and med-derm trained graduates were appreciated, med-derm graduates seem more comfortable with multidisciplinary care and may care for more medically complex patients requiring immunosuppression.

Perceptions of telehealth among inpatient consultative dermatology providers and practice patterns during COVID-19.

Use of inpatient teledermatology increased during the COVID-19 pandemic. We surveyed the Society for Dermatology Hospitalists to better characterize the impact of COVID-19 on teledermatology use by inpatient dermatology providers, particularly on provider perceptions of teledermatology. Prior to the COVID-19 pandemic, 40% (8/20) of surveyed providers had used telehealth at their institution to help perform inpatient consults, while 90% (18/20) adapted use of teledermatology during the pandemic. 80% (16/20) reported that their opinion of teledermatology changed as a result of the COVID-19 pandemic, with the vast majority (87.5%, 14/16) reporting having a more positive opinion. Benefits of teledermatology included efficiency, ability to increase access safely, and ability for clinicians to focus on complex cases. Some providers expressed concerns over the potential implications regarding the perception of dermatology within medicine, limitations of inadequate photos, and breakdowns in communication with consulting teams and patients. Robust algorithms and or utilization criteria of teledermatology may help to mitigate risk, while increasing access to inpatient dermatologic evaluation.

Inpatient Dermatology Consultation Services in Hospital Institutions.

Inpatient dermatology plays a key role in the hospital system. Dermatology-related admissions are frequent, and the correct diagnosis and management of cutaneous conditions is crucial to improving patient outcomes and decreasing health care costs. As a dermatology resident, it can be challenging to perform inpatient consultations, especially early in residency. Focusing on pre-rounding and must-ask questions of requesting providers as well as carrying an organized toolbox will be invaluable for every dermatology resident.