Implementation and outcomes of an inpatient dermatology e-consult pilot service at an academic satellite hospital

Summary: We developed and piloted a dermatology e-consult service for inpatients at a satellite hospital within our academic health system and assessed the patient volume and outcomes associated with the service. An Epic order set for dermatology e-consultation (DEC) was established at the satellite hospital. The on-site wound care team provided all photography and the general surgery team provided biopsies as directed by the consulting dermatologist. Patient volume and procedural outcomes were prospectively recorded, and demographics and outcomes were retrospectively reviewed. Over 18 weeks, 18 inpatient DEC were provided. Of these, 10 patients (56%) were male. The median age was 66 years (range: 27 – 81) and the median hospital length of stay was 5 days(range: 2 – 23). Six patients (33%) required 11 biopsies and three patients (17%) required tissue culture. The most common presumptive diagnosis by the primary team prior to DEC was rash (n=8, 44%). The most common final diagnosis after DEC was drug reaction (n=4, 22%), including drug-induced hypersensitivity syndrome, exanthematous drug reaction, and methotrexate toxicity. Three patients (17%) had an undetermined diagnosis by discharge. The diagnosis changed in 13 cases (72%) following DEC. The primary team was interested in transfer for dermatologic care for six (33%) patients; ultimately, only one patient was transferred given concern for widespread lymphoma. Upon discharge, dermatology recommended outpatient follow up in 10 cases (56%) and no follow up in five cases (28%). There was one readmission (6%) related to dermatologic illness within 30 days of discharge. Two patients (11%) died during admission of causes unrelated to dermatologic illness. The introduction of a dermatology e-consult service for inpatients at a satellite hospital enabled remote evaluation of patients by a dermatologist, allowing for timely diagnosis and direction of care for inpatients with dermatologic illnesses. Jeffrey A. Sizemore¹, Daniela Kroshinsky², Sabrina M. Shearer² 1. Duke University School of Medicine, Durham, NC, United States. 2. Department of Dermatology, Duke University School of Medicine, Durham, NC, United States. Clinical Research: Epidemiology and Observational Research