A targeted response to the COVID‐19 pandemic: analysing effectiveness of remote consultations for triage and management of routine dermatology referrals

Abstract

IntroductionWhen the UK entered lockdown in March 2020 amidst the COVID-19 pandemic, routine dermatology work was suspended as per national guidance 1 to allow for redeployment of staff to the front line and also reducing risk of patient exposure and travel.New patient referrals from primary care into dermatology services usually enter via one of three routes:(i) 2 week wait for suspected serious skin malignancies, (ii) routine non-urgent cases and (iii) emergency referrals (via an on call service). All these patients are assessed via a face-to-face consultation, after various waiting times depending on their urgency.As a result of this suspension just over 800 new routinely referred patients had their appointments temporarily suspended, covering a six week period. Many of these patients had already waited up to 18 weeks for an initial assessment. Furthermore, with the dual challenge of a depleted dermatology workforce and the need for reduced face-to-face consultations during the lockdown, it became imperative to develop new solutions to ensure this cohort of patients would receive care within an appropriate timeframe.To evaluate our response to this challenge we prospectively collected data, with the aim to investigate whether the strategy deployed was an efficient way of assessing this large number of referred patients.We also initiate discussion as to whether this novel method of working could yield a framework for providing a future dermatology service in the event of prolonged social distancing. MethodThe national electronic booking system (ESR) identified the 816 routinely referred patients whose appointments were cancelled, between the dates of 23 rd March to 30 th April 2020. This patient worklist was divided between 15 clinicians (consultants, associate specialists and registrars) working in the department, including those shielding/working from home. 1 www.england.nhs.uk 17.03.2020 Letter to NHS bodies from Sir Simon Stevens Accepted ArticleThis article is protected by copyright. All rights reserved Referral letters were reviewed and patients were contacted via telephone or video calling (Attend Anywhere) 2 . For telephoned patients, each clinician decided if patient photographs would be useful. If so, the patient was directed to send good quality images to a secure NHS email account. Follow-up contact was made with the patient to relay the diagnosis and any further management required.A patient was deemed to be 'uncontactable' if they did not respond to three telephone calls, on separate occasions.Data collected included patient demographics; whether the referral was for a lesion or dermatosis; if a visual element was used in assessing the case (photo or video consultation); and the clinicians' opinion as to who could have made the first contact with the patient (doctor, nurse or administrator) to streamline any future processes.Outcomes recorded included: urgent review; direct booking for non-urgent surgery; routine clinic review (with/without management initiated); and those who could be discharged ...

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