P220 Evaluation of a teledermatology service: a 13-month service audit

Abstract

Teledermatology (TD) services are increasingly used to improve access to specialist dermatology care and reduce unnecessary clinic attendances. Our TD service includes both general practitioner (GP)-led referrals and a dedicated 2-week-wait (2WW) teledermatology cancer pathway. Ongoing evaluation is required to assess service effectiveness, clinical outcomes and interclinician variation. Our aim was to evaluate outcomes of the TD service between April 2024 and May 2025 and to compare performance with previous audit cycles. A retrospective audit of all teledermatology referrals between April 2024 and May 2025 was conducted. Outcomes were categorized as referral back to GP, referral to clinic, direct referral to surgery, insufficient image quality or inappropriate referral. Subgroup analyses were performed for lesion-based referrals, inflammatory conditions and the 2WW only pathway. Outcomes were compared with two previous audit periods from 2022 and 2023. In total 6693 referrals were analysed. Overall, 68% of patients received a definitive outcome without clinic attendance, with 27% referred to clinic. Lesion-based referrals (non-2WW and 2WW; n = 5781) demonstrated 71% definitive outcomes, with 24% requiring clinic review. In the 2WW TD-only pathway (n = 2889), 79% achieved definitive outcomes, with 21% referred to clinic. Inflammatory referrals showed lower definitive outcomes (55%), with higher clinic referral rates (42%). Progressive and statistically significant improvements were observed across audit cycles in both overall and lesion-based TD outcomes. These improvements are likely attributable to enhanced image quality provided by medical photographers, increasing consultant experience and confidence in diagnosis, and a greater proportion of patients being appropriately directed straight to biopsy. TD continues to provide effective triage, particularly for lesion-based and cancer pathways, with progressive improvements over time. Lower performance in inflammatory conditions is most likely related to the complexity of the latter and highlights opportunities for targeted education and standardization.