The value of in-patient dermatology: a survey of in-patients in Scotland and northern England

Abstract

Dermatology in-patient units are frequently threatened with reduction or closure, yet there are few objective data regarding the nature and use of in-patient management with which to assess their value. We have surveyed 300 patients admitted during March 1997 to dermatology units throughout Scotland and Northern England, to establish their clinical and social profile, and the outcome of admission. All departments provided phototherapy and out-patient treatment services, and 84% of those admitted lived within an hour's travel of one of these. Three diagnostic groups (psoriasis, eczema and leg ulcers) accounted for 83% of in-patient days. Patients were admitted principally because of disease severity but many, including half of those with psoriasis, had concurrent medical problems such as alcohol abuse, psychiatric disorder or arthropathy. Many patients with psoriasis and leg ulcers were from socially deprived areas, as defined by low Carstairs index scores, and a similar proportion received income support. Eighteen per cent of patients, mainly those with acute disorders, would have needed admission irrespective of dermatology bed availability. Out-patient management was considered the next best alternative for only 28% of patients, and many patients would have been expected to treat themselves. By contrast, 84% of patients admitted were cleared or substantially improved, or had procedures completed as planned, and another 12% were partially improved. Outcomes were particularly good in psoriasis, eczema and infection groups. We have demonstrated that in-patient management is highly effective in providing remission in chronic skin disease, and our survey also suggests that concomitant disability or social factors mean that for many such patients ambulatory care cannot replace this service.

Audit of admissions to dermatology beds in Greater Manchester

“…Seventeen per cent of patients had significant medical problems contributing to the need for admission. This figure is lower than the 43% recorded in the Scottish series 3 possibly because we classified alcohol and psychological problems as ‘social’ rather than medical and we did not include psoriatic arthropathy in our significant medical problems group. Even so most patients did not have medical problems and the use of costly ‘medical’ beds for these patients is arguably not a legitimate expense.…”

“…This study, amongst few others, 3,4 provides an evidence base for the subjective and objective benefits of inpatient treatment. Importantly patients' quality of life as measured by the DLQI score showed a significant improvement (41.8%) compared with their pre‐admission status.…”

In patient dermatology: characteristics of patients and admissions in Tribhuvan University (TU) Teaching Hospital

“…In these countries the most frequent diagnoses were psoriasis, bullous disorders, chronic ulcers and dermatitis, which represented more than 70% of inpatients. [1][2][3] In Spain surgical patients constituted the majority of inpatients (37%) whereas in Iran bullous disorders constituted around 40% cases. 4,5 Our objectives were to describe inpatient activity in TU Teaching Hospital, a tertiary care centre of Nepal.…”

Patterns of inpatient dermatology referral and predictors of diagnostic accuracy in non‐dermatologists in a Northern District hospital in Singapore

“…Yet there undeniably exist several dermatological conditions that are associated with considerable morbidity and mortality . In addition, several studies have demonstrated that inpatient care may be highly effective in facilitating remission in chronic skin diseases, especially in socially disadvantaged patients . Inpatient admission would therefore be justifiable in such patients.…”