Dermatology consultation service at a large metropolitan hospital system serving minority populations

Abstract

Background Dermatology consultations in the inpatient hospital setting can improve diagnostic accuracy and management. Objective Characterize dermatologic diagnostic and treatment trends in the hospital setting and identify variables that may affect patient care. Methods Retrospective chart review from 1 January 2012 to 31 December 2017 at Jackson Memorial Hospital (JMH) (Miami, Florida, USA), an academic non‐profit tertiary care centre affiliated with University of Miami Miller School of Medicine, was performed. Patients who received dermatology consultations in the emergency department (ED) or inpatient settings were included. Patient demographics, admission information, provisional diagnosis and management plans by primary teams, final diagnosis, management plans and testing recommendations by the dermatology consults team, and follow‐up information were collected. Analysis using Microsoft Excel of how time to consultation, admission length, inpatient versus ED setting and primary team affected diagnostic accuracy was also performed. Results The 1004 consultations for 812 patients (n = 812) were reviewed (359 women, 453 men). Most patients were Hispanic (n = 359; 44.2%) or African American (n = 273; 33.6%). Mean admission length was 20.6 days (range 0–439; median 6). The most common consulting service was internal medicine (n = 452). In 387 cases (47.6%), primary teams did not give a provisional diagnosis. The most common provisional diagnoses were bacterial infection (n = 93), viral infection (n = 49) and drug reaction (n = 44). The most common diagnoses by dermatology were viral infection (n = 93), bacterial infection (n = 90) and drug reaction (n = 80). Dermatology consultation changed the provisional diagnosis in 55.7% of cases, more often in cases where consultation took place ≥2 days after admission (P < 0.05). Primary teams followed dermatology treatment recommendations in 85.2% of cases. Conclusion Dermatology consultation improves diagnostic accuracy in skin disorders in the hospital setting and serves as a valuable resource for inpatient care. A notable aspect of data from this study is the unique patient population, predominantly comprised of underrepresented racial and ethnic minorities including Hispanics and African Americans.

Inpatient dermatology consultations during COVID 19 pandemic in a tertiary referral center

“…Almost all of these indications were common skin disorders, none of them were rare diagnosis. The inflammatory skin disorders and cutaneous infections have been reported to be most common clinical diagnoses in dermatology consultations in most of the large hospital series before COVID pandemic similar with our study 3 …”

“…The role of dermatology consultations have been reviewed in many large hospital centers either in different departments such as emergency, hematology and transplantation units or in different indications selecting only one category such as inflammatory disorders or cutaneous infections 3‐6 In our study skin disorders were classified into several subgroups according to their etiology and it was seen that the most common consultation requests were made by COVID services including wards and intensive care unit (n = 54, 32.5%).…”

Inpatient Dermatology Consultations in a General Surgery Ward in a Tertiary Hospital in China: A Retrospective Study of 251 Patients

“…Dermatology is primarily an outpatient-based service; however, dermatologists also play essential roles in providing dermatology consultations to inpatients hospitalized for care in other speciality disciplines [1,2]. Timely and accurate dermatology consultations can benefit the hospitalized patients in terms of diagnosis and treatment of skin diseases [3,4]. A retrospective study of 731 referrals for dermatology consultations showed that there was not always a good correspondence between the provisional diagnoses made by the referring doctors and the final diagnoses confirmed by dermatologists, with 30.2% correct diagnoses, 35.2% incorrect diagnoses, and 34.6% no provisional diagnoses [5].…”

“…The diagnoses of skin diseases were made according to the International Classification of Disease, 10th Revision. Diseases were classified by two of the authors (HZ and KT) according to previously published articles on inpatient dermatology consultations [2,4,10,12], and the classification was re-checked by another two authors (HJ and QS, both professors in dermatology). This study was approved by the Institutional Review Board at Peking Union Medical College Hospital (Number: S-K1589).…”

Retrospective analysis of 578 inpatient dermatology consultations in hematology and hematopoietic stem cell transplant patients

“…[5][6][7][8] These patients account for a variable proportion of consultations, with Fayne et al's finding just 0.7% of consultations were from hematology/ oncology services and Tracey et al's finding 23% from bone marrow transplant services. 5,9 The objective of our study was to investigate the role of dermatologists in the care of hospitalized…”