Dermatologists in Hospital Wards: An 8-Year Study of Dermatology Consultations

Abstract

Background: The value of dermatologists as consultants is increasing. Objective: To evaluate the activity of dermatologists as inpatient consultants. Methods: Retrospective study of consultations to Dermatology of inpatients, visits per consultation, referral service, procedures performed, delay until visit and diagnoses based on ICD-9. Results: 3,144 requests generated 4,824 visits, 200 biopsies, 107 cultures and other procedures. The mean delay between request and visit was 0.75 days. The requesting service was recorded in 3,097 cases: 21.5% by Internal Medicine, 11.4% by Pediatrics, 8.3% by Neurology and 6.2% by the Infectious Diseases Unit. Follow-up was recommended in 12.4% by the Dermatology Service and in 8% by a dermatologist. Reliable diagnoses were recorded for 2,832 consultations. The most frequent diagnostic groups were diseases of the skin and subcutaneous tissue (ICD-9: 680–709) in 58%, infectious and parasitic diseases (ICD-9: 001–139) in 20%, and neoplasm (ICD-9: 140–239) in 5.7%. The most frequent diagnoses were contact dermatitis (ICD-9: 692.X) in 8.9%, drug reactions (ICD-9: 693.0) in 7.4%, candidiasis (ICD-9:112.X) in 7.1% and seborrheic dermatitis (ICD-9: 690) in 5.3%. Conclusions: Most diagnoses were of a specific cutaneous disease and the dermatologist would be in the best position to evaluate those that inpatients acquire.

Inpatient dermatological consultations in a university hospital

“…Dermatology is primarily an outpatient clinical and surgical specialty, but it also plays important roles in the care of inpatients who are admitted to dermatology beds and other services 1-3. With the advent of effective and more cosmetically acceptable creams and phototherapy, the patterns of inpatient care are undergoing changes; in addition, the introduction of oral immunosuppressive agents has broadened the scope of outpatient therapy 3.…”

“…With the advent of effective and more cosmetically acceptable creams and phototherapy, the patterns of inpatient care are undergoing changes; in addition, the introduction of oral immunosuppressive agents has broadened the scope of outpatient therapy 3. As a result of the changing conditions of medical care, the number of patients admitted to dermatology services is decreasing, while the value of dermatologists as consultants within the hospital setting is increasing 1. Approximately 20% of the general population have skin diseases that are treated by local or systemic therapies, and therefore, it seems clear that inpatients would suffer numerous skin complaints regardless of the disease that led to hospitalization 1.…”

Acutely Ill Patients in Internal Medicine Departments Want Treatment for Undiagnosed, Symptomatic Skin Conditions

“…Although one can legitimately ask whether the observed dermatological conditions were causally related to internal diseases, we did not find any evidence of this in our study population [8,9,10,11,12,13,14,15]. However, the present study sought to identify dermatoses with a high prevalence; with a larger sample size, rarer internal disease-related dermatoses might be detected.…”

Dermatology, an interdisciplinary approach between community and hospital care

“…5–7 GPs are the first port of contact for patients, with 24% of GP consultations relating to skin conditions. 8 Skin conditions form the third most common reason for presentation to the GP, after respiratory and nervous system related conditions.…”

“…The literature suggests that the vast majority of dermatological conditions 5,13 can be resolved with a single admission, suggesting the majority of admitted cases involve common conditions with a clear diagnosis and consequent therapeutic regime. Kirsner et al.…”