Inpatient Dermatology referrals: What is the burden? A retrospective review of 14 years of dermatology inpatient referrals

Abstract

Background: The lack of dermatological knowledge by non-dermatologists is exposed by the increasing number of requests made for inpatient dermatological consultations. Patients have been commenced on inappropriate treatment because of poor dermatology training.

Objectives: To determine the burden and accuracy of inpatient dermatology referrals.

Methods: A retrospective cohort study using paper inpatient dermatology referrals from one Health Board between June 2007 and July 2021. Data analysis included timing of referrals; referring speciality; diagnosis and treatment. Descriptive statistics, using Excel, were used for analyses.

Results: The average number of referrals per year was 106 (79-166). The most frequent day of referral was Monday (26%). Most referrals were from medical teams (73%).Differential diagnosis was suggested by the referring team in 59% of referrals. In only 29% of referrals the dermatology team agreed with the differential diagnosis. There was discrepancy in the correctness of diagnosis in all categories, however the paediatricians were most likely to offer a correct differential (44%). In 44% of referrals treatment was commenced by the referring team, most commonly antibiotics.

Conclusions: There is an extra burden on dermatology teams to cover inpatients. Our figures highlight two important issues - the need for better dermatological education in medical schools to improve diagnosis accuracy and management of conditions as well as the need to recognise the need for an inpatient dermatology service to review inpatient referrals and advise in diagnosis and management of dermatology cases on the wards, and to protect the service from being uncoupled from the main hospital.