Oral Presentation 2015 Annual Meeting of the Australasian Society for Dermatology Research

Inpatient dermatology referrals from an Australian tertiary hospital (#45)

Nigel G Maher 1 2 , Richard Haber 3 , Nancy Todes-Taylor 1 4 , Mei-Heng Tan 1 , Dedee F Murrell 1 2
  1. Department of Dermatology, St George Hospital, Kogarah, Sydney, NSW, Australia
  2. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
  3. Section of Dermatology, University of Calgary, Calgary, Alberta, Canada
  4. Kaiser Permanente Medical Group, San Rafael, California, USA

Introduction

Dermatology training in Australian medical schools, and in prevocational medical training is often limited. There is little published evidence to describe the nature of inpatient dermatology referrals in an Australian population.

Purpose

The aims of this study were firstly, to describe the nature of inpatient referral work encountered in an Australian tertiary hospital by a dermatology team. Secondly, it was help identify how further educational efforts could be directed to help train students and non-dermatology doctors. 

Methods

A prospective cohort study from all inpatient dermatology consultations over a 9.5month period from one Australian tertiary hospital was conducted. Details recorded included reason for consultation, duration of the skin issue prior to consultation, consultant dermatology diagnoses made, if dermatology treatment was recommended, and the need for skin biopsy.

Results

There were 220 inpatient dermatology consultations over the study period. The most frequent reasons for dermatology consultation were unspecified rash or lesion (64 patients, 29%), non-scabetic skin infection (49 patients, 22%), autoimmune/allergy reason (30 patients, 14%) and a drug reaction (24 patients, 11%). There were 260 total dermatology diagnoses given, and the dermatology team differed from the referring team’s provisional diagnosis for 149 patients (67.7%). The main differences were due to dermatitis and skin infection diagnoses. The most common durations of the skin issue(s) prior to dermatology consultation were 1-12months (70 diagnoses, 27%), followed by 8-31 days (53 diagnoses, 20%). Additional treatment suggested by the dermatology team occurred in 159 patients (72%), and 94 patients (43%) required a skin biopsy.

Limitations

The inpatient dermatology diagnosis remained unknown in 34 patients (15%).

Conclusion

The majority of dermatology consultations were for a non-specified rash or lesion, and dermatology consultation frequently provided additional patient care suggestions. Further education for non-dermatology practicing doctors should be directed especially towards dermatitic and infectious skin pathologies.