P221 Optimizing dermatology advice and guidance referrals: a quality improvement project to enhance triage and decision making

Abstract

Dermatology Advice and Guidance (A&G) services support primary care clinicians, reduce unnecessary appointments, and improve access to specialist input. Their effectiveness depends on the provision of adequate clinical detail, high-quality images and information that enables remote clinical decision making. Poor-quality referrals can delay care, increase back-and-forth communication, and lead to avoidable secondary care referrals. Within our trust, all referrals, except 2-week wait, are screened via A&G to ensure appropriate patients are seen within secondary care. This quality improvement project aimed to evaluate and improve the quality and efficiency of dermatology A&G referrals. The first cycle analysed referrals submitted in September 2022 (n = 150). The second cycle, in September 2024, was performed following recommendations to primary care (n = 195). Data collected included referral content, completeness of history, quality of images, need for additional information, general practitioner (GP) response rates to follow-up queries, referral outcomes including whether cases could be managed in intermediate care, conversion rate to appointments, and use of snippets. Referral quality improved between cycles. Additional information requested reduced from 37% to 14%. Photo submissions decreased by 2.5% and ­adequate-quality photos declined by 11.6%. GP response rates to follow-up requests were unchanged, with one-third responding to original information requested. Approximately one-half of referrals could have been managed within primary or intermediate care. Appointment requests increased from 38.7% in 2022 to 45.6% in 2024. In 2024, 13% of requests were 2-week-wait referrals, compared with 0% in 2022. Of the 2024 requests, 18% were accepted for teledermatology and 69% for face-to-face appointments, compared with 20.7% and 79.3%, respectively, in 2022. Use of response snippets increased from 9% to 27%, demonstrating enhanced utilization of structured response tools. This quality improvement project highlights significant opportunities for service optimization. Targeted education on image acquisition, referral standards and focused education sessions on common conditions may enhance decision making, optimize triage and reduce the need for specialist appointments.