Urgent Consultations at the Dermatology Department of Basel University Hospital, Switzerland: Characterisation of Patients and Setting - A 12-Month Study with 2,222 Patients Data and Review of the Literature

Wagner

et al. 2019

Summary Background In recent years, emergency consultations have become more common in all medical disciplines. In Germany, dermatological out‐of‐hours consultations are handled by emergency practices, emergency departments and tertiary care providers. Little information is available on the reasons for these dermatological consultations. Objectives The aim of this study was to analyze patient characteristics, diagnoses and admission rates resulting from these consultations. Methods We conducted a retrospective study covering two years of out‐of‐hours consultations at a dermatological tertiary referral center. Results A total of 3635 patients presented at the referral center. The most frequent outpatient diagnoses were acute urticaria (13.8 %) and bacterial infections (12.3 %). 83 % of the outpatient diagnoses required the most advanced competence level according to the new German curriculum for undergraduate education of medical students. 405 (11.01 %) patients did not require dermatological treatment, and 430 patients (13.6 %) were admitted to hospital. Most admissions were due to bacterial infections and herpes zoster. Advanced age, pain and fever were associated with a relatively high risk of admission. Conclusions Admission rates at the dermatological tertiary referral center were substantially lower than at interdisciplinary emergency departments. A few diagnoses accounted for more than half of all consultations. These diagnoses are well represented within the new German curriculum.

“…A similar situation has been described by Ruzza et al. in Switzerland . Demand for healthcare services is increasing and patients appear to seek specialized dermatological care directly.…”

Section: Discussionsupporting

confidence: 72%

Two‐year analysis of dermatological out‐of‐hours consultations at Frankfurt University Hospital

Wagner

et al. 2019

“…In comparison to Ruzza et al. , a similar number of diagnostic procedures was performed, but we observed a slightly higher number of microbiological smears and blood tests, and a lower number of punch biopsies.…”

Section: Discussionsupporting

confidence: 44%

“…This proportion of emergency patients observed is consistent with the results of a study performed by Ruzza et al. .…”

Section: Resultsmentioning

confidence: 99%

“…This mirrors an adaptation of the widely available variety of therapeutic options to a mostly symptomatic anti‐inflammatory, antipruritic or antimicrobial treatment, when strong and fast relief is expected instead of a fine‐tuned treatment concept conducted when patients have a regular appointment. However, the percentage of patients who are treated systemically at our EDU is far higher than that reported by Ruzza (39 % vs. 26 %) . This is probably due to the large number of emergency consulting patients who state itching as a primary symptom and have antihistamines prescribed .…”

Section: Discussionmentioning

confidence: 99%

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Resources spent on dermatological emergency patients: A twelve‐month prospective data collection from Germany

Ansorge

Miocic

Bubnoff

et al. 2019

Summary Background and objectives Rising numbers of patients consulting emergency units are associated with an increased demand for material and personnel. In order to better quantify these resources, we performed an analysis of diagnostic procedures, treatment types, and the quantity and educational level of staff involved in emergency consultations. Patients and methods The study was conducted as a prospective single‐center survey over twelve months in the dermatology unit of a Germany university hospital. 3155 consultations were included by consecutive sampling. Results Diagnostic tests (e.g. microbiological swab, blood testing, punch biopsy) were performed in 29 % of all consultations. Physicians prescribed treatment in 70 % of cases, with steroids and antihistamines being the most frequent topical and systemic treatment, respectively. Each patient was seen by at least one physician and a nurse, and in 25 % of cases an additional physician was involved. Less than thirty minutes was required for the consultation in the vast majority of cases. On average, emergency consultations required two hours per day of the treating physician's time, not including the time of other involved staff such as nurses and laboratory technicians. Conclusions This study demonstrates the extent of resources involved in the treatment of dermatological emergency consultations.

“…Dies spiegelt den freien Zugang zu Gesundheitsdiensten im deutschen Gesundheitssystem wider. Eine vergleichbare Situation wurde von Ruzza et al für die Schweiz beschrieben . Der Bedarf an Gesundheitsdienstleistungen steigt und die Patienten scheinen unmittelbar die spezialisierte dermatologische Versorgung anzustreben.…”

Section: Diskussionunclassified

Zweijährige Analyse dermatologischer Konsultationen außerhalb der Sprechzeiten am Universitätsklinikum Frankfurt

Wagner

et al. 2019

Zusammenfassung Hintergrund In den letzten Jahren ist die Anzahl der der Notdienstpatienten fächerübergreifend angestiegen. In Deutschland werden dermatologische Vorstellungen außerhalb der Sprechzeiten durch den ärztlichen Bereitschaftsdienst, Notaufnahmen und tertiäre Gesundheitsdienstleister wahrgenommen. Es liegen nur wenige Informationen über die Gründe dieser dermatologischen Konsultationen vor. Ziele Ziel der Studie war es, die Patientencharakteristika und die Diagnosen zu analysieren sowie die sich aus den Konsultationen ergebende Aufnahmerate. Die Aufnahmeraten zu bestimmen, die aus diesen Konsultationen resultieren. Methoden Wir führten eine retrospektive Analyse durch, die die dermatologischen Konsultationen außerhalb der Sprechzeiten in einem tertiären Referenzzentrum über einen Zeitraum von zwei Jahren erfasste. Ergebnisse Insgesamt stellten sich 3635 Patienten im Referenzzentrum vor. Die häufigsten ambulanten Diagnosen waren akute Urtikaria (13,8 %) und bakterielle Infektionen (12,3 %). Gemäß dem „Nationalen Kompetenzbasierten Lernzielkatologs Medizin“ (NKLM) wurden 83 % der ambulanten Diagnosen die höchste Kompetenzebene zugewiesen. 405 Patienten (11,01 %) benötigten keine dermatologische Behandlung, während 430 Patienten (13,6 %) stationär aufgenommen wurden. Die meisten Aufnahmen waren die Folge von bakteriellen Infektionen und Herpes Zoster. Fortgeschrittenes Alter, Schmerz und Fieber waren mit einer hohen Wahrscheinlichkeit einer Aufnahme assoziiert. Schlussfolgerungen Die Aufnahmeraten in einem tertiären dermatologischen Referenzzentrum waren wesentlich geringer als in interdisziplinären Notaufnahmen. Einige wenige Diagnosen waren für mehr als die Hälfte aller Konsultationen verantwortlich. Diese Diagnosen sind im NKLM gut abgebildet.