A New Virtual Inpatient Dermatology Electronic Referral Service: A Timely Answer To Reducing Cross-Contamination During The Covid-19 Pandemic?

BT03 Performance outcomes for and impact on the dermatology service of a medical photographybased store-and-forward model digitized teledermatology pathway with over 8000 patients in an urban setting I. Palamaras, H. Wark, B. Short, O.A. Hameed, A.A. Sheraz, P. Thomson, K. Kallirai and L. Rose Royal Free NHS Foundation Trust, London, UK A new, store-and-forward fully digitized teledermatology (TD) pathway was designed and implemented in an urban setting for non-2-week-wait routine patients modelled on evidencebased published studies and national guidelines. Analysis was carried out of both retrospectively retrieved and proactively collected data from our bespoke designed TD digital system built into the wider electronic patient record system. Analysis included records from 1 January 2017 to 23 March 2020. A patient experience survey was also distributed to 59 patients. In total 8352 new patients had a TD consultation over 37 months. Of these, 4748 (56 5%) were referred back to their general practitioner (GP; either with expert management advice or because no further treatment was required), In total, 1634 (19 6%) were referred directly for a surgical procedure and 1970 (23 6%) for a face-to-face (F2F) review with a dermatologist. Of those referred back to their GP, 80% of diagnoses were accounted for by seborrhoeic keratosis (50%), benign melanocytic naevus (15%), actinic keratosis (10%) and dermatofibroma (5%). The average waiting time for a TD appointment was 3 weeks vs. 30 weeks for a routine F2F appointment. Comparing April–September between 2019 and 2018, TD referrals rose by 38%, routine dermatology referrals reduced by 16% and cancer referrals increased by 6%. Using medical photographers proved to be effective with only two cases (0 02%) of images being of insufficient quality to form a clinical opinion. Overall savings for the local commissioning groups were estimated to be £671 218. Last financial year savings were £253 517. The average cost saving per TD patient appointment was £80 36. Overall savings in the Trust’s overhead costs were £53 587. TD consultants reviewed almost twice the number of patients vs. F2F for the same number of consultant programmed activities. Ninety-five per cent of surveyed patients would be likely or extremely likely to recommend this service to friends and family. This is a successful TD service that provides early access to specialists for patients, a safe and effective clinical service, easy access with care close to home, education in primary care, improved efficiency in secondary care (where specialist dermatologists are a scarce resource), financial benefits for the wider healthcare economy and the ability to report more dynamically on clinical quality and performance through our bespoke platform. BT04 A new virtual inpatient dermatology electronic referral service: a timely answer to reducing crosscontamination during the COVID-19 pandemic? A. Lowe, A. Pararajasingam, F. Ali, S. Dawood, C. Lowe and N. Stone Department of Dermatology, Royal Gwent Hospital, Newport, Gwent, UK; Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, UK; and Department of Biosciences, Swansea University, Swansea, UK Teledermatology in the inpatient hospital setting is not as well established as in the outpatient setting. Data suggest that it may be effective in managing dermatological disease in hospital inpatients, with the added benefit of reducing response time for the referring medical team. Our local health board covers a relatively large geographical area, compared with the population it serves, and is spread across six different hospital sites. The traditional paper-based referral system was inefficient and outdated, with inequitable access to a dermatology opinion across peripheral hospital sites. We designed, implemented and evaluated an entirely electronic, virtual, inpatient dermatology referral system to replace the historic paper and face-to-face (F2F) service. Referrals were received using an online referral pathway and high-quality images (taken by professional medical photographers) uploaded onto a secure electronic portal. Dermatology registrars reviewed the clinical information and images, relaying advice back to the referring clinicians. Outcomes data from referrals received over a 10week period were analysed to assess effectiveness. A 5-point Likert scale was used to assess registrar confidence in managing inpatient referrals virtually. Eighty-four per cent of referrals (n = 95) were dealt with successfully virtually, without conversion to F2F. The average time from referral to completion of review was 1 9 days. Sixty-six per cent were dealt with within 24 h and 77% within 48 h. The rate-limiting step was waiting for images to be uploaded onto the electronic portal following the referral. Registrars felt highly confident in managing referrals virtually in most cases (62%), slightly confident in 21% and were not confident in only 7%. Our study demonstrated that most inpatient referrals can be managed confidently virtually, thereby increasing efficiency, reducing travel time and obviating the need for F2F ward visits in a safe, timely and equitable manner. This is of particular significance in the present COVID-19 pandemic, reducing the attendant risks of cross-contamination between sites. This format also lends itself to peer review of images and virtual ward rounds, F2F versions of which are presently limited as a result of social distancing requirements. It has the potential to contribute to the education and training of registrars, particularly in meeting their teledermatology training needs, a boon in our current landscape where registrar training has invariably been affected by altered patient flow during the pandemic.