P085 Referrals in dermatology: a retrospective review

Abstract

Inpatient dermatology units are facing a growing burden of referrals from other medical and surgical specialties, placing substantial pressure on clinicians as they manage this alongside routine departmental responsibilities. Anecdotal observations suggested that some referrals may be inappropriate for the inpatient pathway, contributing to avoidable service pressure. This study evaluated the quality and appropriateness of inpatient dermatology referrals across three hospital sites. Secondary objectives included developing strategies to improve referral quality and streamline referral pathways. A retrospective review was conducted of all inpatient dermatology referrals submitted via the electronic patient record (Cerner) from 1 September 2024 to 31 October 2024 across three hospitals. Data collected included referral demographics, reason for referral, photographic documentation and initial management recommendations. Repeat referrals for the same patient were excluded when they represented duplicate submissions for the same issue. Subsequent referrals were included if they concerned a new clinical problem or required further dermatology input. In total, 370 referrals were analysed. The highest number of referrals originated from general internal medicine, followed by acute medicine and several out­patient services including same-day emergency care for medicine (SDEC), ambulatory infectious diseases unit, and the oncology day-case unit. Referral quality was suboptimal, with only 106 referrals (28.6%) containing photographs, and 141 referrals (38.1%) did not provide a clinical description of the rash. A considerable proportion of referrals were due to nondermatological conditions, frequently relating to conditions such as cellulitis, venous eczema, herpes simplex virus infection, pressure ulcers and scabies. Introducing mandatory photographic documentation and clear referral guidelines for hospital teams may improve the quality of referrals received and reduce delays in providing clinical advice. Developing streamlined referral pathways, alongside implementing a dermatology ‘hot clinic’ offering same-day emergency care, could further enhance service efficiency and reduce the burden of referrals.