1
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Vaccarello A, Ouyang K, Treichel AM, Kumar Y, Sharma TR. Diagnostic discordance of Stevens-Johnson syndrome and toxic epidermal necrolysis between dermatologists and primary inpatient teams: a single-institution retrospective chart review. Arch Dermatol Res 2024; 316:128. [PMID: 38662244 DOI: 10.1007/s00403-024-02867-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/12/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Affiliation(s)
| | - Kelsey Ouyang
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Alison M Treichel
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Yash Kumar
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Timmie R Sharma
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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2
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Hydol-Smith JA, Gallardo MA, Korman A, Madigan L, Shearer S, Nelson C, Fisher K, Hoffman K, Dominguez A, Kaffenberger BH. The United States dermatology inpatient workforce between 2013 and 2019: a Medicare analysis reveals contraction of the workforce and vast access deserts-a cross-sectional analysis. Arch Dermatol Res 2024; 316:103. [PMID: 38485858 PMCID: PMC10940353 DOI: 10.1007/s00403-024-02845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/02/2024] [Accepted: 02/09/2024] [Indexed: 03/18/2024]
Abstract
While time spent practicing inpatient dermatology has decreased since the 1990s, less is known about the current state of inpatient dermatology. We describe the distribution and frequency of inpatient dermatology encounters servicing the United States Medicare population between 2013 and 2019. Cross-sectional analysis of publicly available inpatient Medicare Part B claims data from 2013 to 2019 was conducted. Main outcomes and measures were characteristics and trends of dermatologists performing inpatient encounters. Categorical variables were compared using χ2 analysis. Trends were analyzed for linearity using Pearson correlation coefficient. 782 physicians met inclusion criteria for inclusion. Dermatologists were more often male (56.5%), possessing allopathic Medical Doctorate (MD) (86.3%), and in metropolitan settings (98.2%). However, proportion of female inpatient dermatologists increased significantly (37.9% to 46.2%). Across rural and metropolitan practices, number of inpatient physicians (2013: 356; 2019: 281) and number of medical centers in which dermatology encounters occurred (2013: 239; 2019: 157) decreased, more significantly in non-residency-associated institutions. Spatial analysis revealed wide regions lacking dermatologists meeting defined criteria. Limitations included the need for ten Medicare inpatient encounters for inclusion, counties without reported data. In conclusion, the number of dermatologists performing > 10 inpatient encounters per year is decreasing, and large variations exist in the number of U.S. inpatient dermatology visits.
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Affiliation(s)
| | | | - Abraham Korman
- Department of Dermatology, The Ohio State University Wexner Medical Center College of Medicine, 1328 Dublin Rd. Suite #100, Columbus, OH, 43201, USA
| | - Lauren Madigan
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Sabrina Shearer
- Department of Dermatology, Duke University School of Medicine, Durham, NC, USA
| | - Caroline Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Kristopher Fisher
- Department of Dermatology, The Ohio State University Wexner Medical Center College of Medicine, 1328 Dublin Rd. Suite #100, Columbus, OH, 43201, USA
| | - Kalyn Hoffman
- Department of Dermatology, The Ohio State University Wexner Medical Center College of Medicine, 1328 Dublin Rd. Suite #100, Columbus, OH, 43201, USA
| | - Arturo Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin H Kaffenberger
- Department of Dermatology, The Ohio State University Wexner Medical Center College of Medicine, 1328 Dublin Rd. Suite #100, Columbus, OH, 43201, USA.
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3
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Ferreira IG, Almeida CS, Bulcão LA, Ferreira DG, Weber MB, Bonamigo RR. Hospital Dermatology: analysis of dermatological consultations in a tertiary teaching hospital. An Bras Dermatol 2023; 98:620-634. [PMID: 37164792 PMCID: PMC10404506 DOI: 10.1016/j.abd.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND In hospital settings, dermatology can offer substantial clinical support for the diagnosis and management of skin conditions, reducing morbidity and mortality. Thus, the study aimed to analyze the profile of referrals and consultations performed by the Dermatology Service of the Santa Casa de Misericordia de Porto Alegre, from August 2018 to January 2020. METHODS This study is descriptive, quantitative, and retrospective, conducted through data collection and review of medical records and referrals. The variables included were clinical data of referrals, in-patients profiles, dermatological diagnoses, complementary exams, therapeutic conduct, and recommended follow-ups. RESULTS A total of 1020 referrals were analyzed, which resulted in 641 consultations (328 men, 313 women). The most prevalent skin disease groups were 'Dermatitis and Eczema' (33.1%) and 'Other infectious skin diseases (21.8%), while the most frequent ICD-10 were 'Drug eruptions - L27' (9.9%) and 'Other and unspecified dermatitis - L30' (6.6%). Corticoids were the most recommended treatments (27.7%), followed by antifungals (13.1%). 'Consultation Discharge' (44%) and 'Outpatient' Dermatology follow-up (27%) were the most frequent causes for ending consultation. STUDY LIMITATIONS Among the study limitations, the authors highlight its retrospective nature, with data analysis based on referrals and medical records, which may present inaccurate or incomplete information. In addition to this, the study may demonstrate a certain degree of subjectivity due to the review and interpretation process conducted by the researchers. However, the definition of objective criteria based on previous studies attenuates such possible bias. Furthermore, considering that the Dermatology teams are composed of a preceptor dermatologist and residents, the established diagnoses were not submitted to third-party verification, except in the cases of skin biopsies and cultures. Thus, the professional's experience and skills may have influenced the dermatological diagnoses. CONCLUSIONS These findings underlie the importance of Dermatology in hospital assistance, contributing to the management of a wide range of skin conditions.
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Affiliation(s)
- Iago Gonçalves Ferreira
- Dermatology Service, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, RS, Brazil; Department of Dermatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.
| | | | - Lucas Abascal Bulcão
- Department of Dermatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Diego Gonçalves Ferreira
- Department of Dermatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Magda Blessmann Weber
- Dermatology Service, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, RS, Brazil; Department of Dermatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Renan Rangel Bonamigo
- Dermatology Service, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, RS, Brazil; Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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4
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Reimer C, Lee E, Wysong A, Georgesen C. Quantitative Benefit of Inpatient Dermatology Services on Hospital Length of Stay in an Academic Hospital. Cureus 2023; 15:e43519. [PMID: 37719626 PMCID: PMC10501321 DOI: 10.7759/cureus.43519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Dermatologic disease has been shown to have high rates of diagnostic and treatment discordance between dermatologists and non-specialists. Inpatient dermatology consultative services have the potential to improve patient care, but there is a paucity of data evaluating the quantitative effects of such services. This study aimed to evaluate the impact a newly established inpatient dermatology service had on quantitative patient care outcomes. METHODS This retrospective cohort study compared quantitative care measures of dermatologic inpatients during the years both pre- and post-implementation of an academic hospital's dermatology consultative service. The primary outcomes included hospitalization duration, readmission rates, and establishment of outpatient dermatologic care. RESULTS The study found a 1.04-day reduction in hospital length of stay (p-value = 0.046) after the consultation service establishment. Additionally, there was a significant increase in the rate by which patients sought outpatient dermatology follow-up (6.7% versus 24.4%, p-value <0.001). No significant change in the all-cause readmission rate was identified. CONCLUSION The reduction of hospitalization duration supports inpatient dermatology services as a viable means to provide improved patient care and reduce health systems costs. Hospitals that do not have a consulting service for cutaneous conditions provided by a dermatology specialist should strongly consider establishing such a department.
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Affiliation(s)
- Camilla Reimer
- Department of Dermatology, University of Nebraska Medical Center, Omaha, USA
| | - Erica Lee
- Department of Dermatology, University of Nebraska Medical Center, Omaha, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, USA
| | - Corey Georgesen
- Department of Dermatology, University of Nebraska Medical Center, Omaha, USA
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5
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Kling SMR, Aleshin MA, Saliba-Gustafsson EA, Garvert DW, Brown-Johnson CG, Amano A, Kwong BY, Calugar A, Shaw JG, Ko JM, Winget M. Evolution of a Project to Improve Inpatient-to-Outpatient Dermatology Care Transitions: Mixed Methods Evaluation. JMIR DERMATOLOGY 2023; 6:e43389. [PMID: 37632927 PMCID: PMC10335331 DOI: 10.2196/43389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND In-hospital dermatological care has shifted from dedicated dermatology wards to consultation services, and some consulted patients may require postdischarge follow-up in outpatient dermatology. Safe and timely care transitions from inpatient-to-outpatient specialty care are critical for patient health, but communication around these transitions can be disjointed, and workflows can be complex. OBJECTIVE In this 3-phase quality improvement effort, we developed and evaluated an intervention that leveraged an electronic health record (EHR) feature, known as SmartPhrase, to enable a new workflow to improve transitions from inpatient care to outpatient dermatology. METHODS Phase 1 (February-March 2021) included interviews with patients and process mapping with key stakeholders to identify gaps and inform an intervention: a SmartPhrase table and associated workflow to promote collection of patient information needed for scheduling follow-up and closed-loop communication between dermatology and scheduling teams. In phase 2 (April-May 2021), semistructured interviews-with dermatologists (n=5), dermatology residents (n=5), and schedulers (n=6)-identified pain points and refinements. In phase 3, the intervention was evaluated by triangulating data from these interviews with measured changes in scheduling efficiency, visit completion, and messaging volume preimplementation (January-February 2021) and postimplementation (April-May 2021). RESULTS Preintervention pain points included unclear workflow for care transitions, limited patient input in follow-up planning, multiple messaging channels (eg, EHR based, email, and phone messages), and time-inefficient patient tracking. The intervention addressed most pain points; interviewees reported the intervention was easy to adopt and improved scheduling efficiency, workload, and patient involvement. More visits were completed within the desired timeframe of 14 days after discharge during the postimplementation period (21/47, 45%) than the preimplementation period (28/41, 68%; P=.03). The messaging workload also decreased from 88 scheduling-related messages sent for 25 patients before implementation to 30 messages for 8 patients after implementation. CONCLUSIONS Inpatient-to-outpatient specialty care transitions are complex and involve multiple stakeholders, thus requiring multifaceted solutions. With deliberate evaluation, broad stakeholder input, and iteration, we designed and implemented a successful solution using a standard EHR feature, SmartPhrase, integrated into a standardized workflow to improve the timeliness of posthospital specialty care and reduce workload.
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Affiliation(s)
- Samantha M R Kling
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Maria A Aleshin
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Erika A Saliba-Gustafsson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Donn W Garvert
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Cati G Brown-Johnson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Alexis Amano
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Ana Calugar
- Ambulatory Quality Department, Stanford Health Care, Stanford, CA, United States
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Justin M Ko
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Marcy Winget
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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6
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Puri P, Pollock BD, Yousif M, Bhullar PK, Boudreaux BW, Fox LP, Rosenbach M, Pittelkow MR, Mangold AR. Association of society of dermatology hospitalist institutions with improved outcomes in Medicare beneficiaries hospitalized for skin disease. J Am Acad Dermatol 2023:S0190-9622(23)00156-1. [PMID: 36736624 DOI: 10.1016/j.jaad.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Pranav Puri
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Benjamin D Pollock
- Department of Health Services Research, Mayo Clinic, Jacksonville, Florida
| | - Miranda Yousif
- University of Arizona College of Medicine, Phoenix, Arizona
| | | | | | - Lindy P Fox
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.
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7
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Creadore A, Manjaly P, Tkachenko E, Li DG, Kaffenberger B, Shinkai K, Rosenbach M, Joyce C, Mostaghimi A. The utility of augmented teledermatology to improve dermatologist diagnosis of cellulitis: a cross-sectional study. Arch Dermatol Res 2022; 315:1347-1353. [PMID: 36580098 PMCID: PMC9798350 DOI: 10.1007/s00403-022-02517-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
Dermatology consultation for cases of presumed cellulitis improves diagnostic accuracy and management. However, access to in-person consultation remains limited, a gap that could be filled with teledermatology. Augmented teledermatology may improve outcomes. In this cross-sectional study, 20 dermatologists (60% of whom reported conducting inpatient consults > 1 month per year) reviewed 10 real-life cases representing either cellulitis or pseudocellulitis as diagnosed by in-person dermatology consultation. For each case, respondents recorded their diagnosis, confidence, and management decisions after viewing the history and standard teledermatology photos, the responses to a physician-reported cellulitis questionnaire, and finally thermal images. Overall mean diagnostic accuracy increased from 84 ± 4% with the history and physical to 89 ± 3% when adding a cellulitis questionnaire and thermal images (p = 0.23). Accuracy for cellulitis cases specifically significantly increased from 76 ± 6% to 88 ± 4% when adding a cellulitis questionnaire and thermal images (p = 0.049). Accuracy for pseudocellulitis was consistently ≥ 94%. Augmented teledermatology with a standardized questionnaire and thermal images improved diagnostic accuracy for cases of cellulitis and may increase physician confidence. Dermatologists were able to accurately diagnose regardless of experience with inpatient consults, increasing the pool of potential dermatologists who could diagnose cellulitis remotely.
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Affiliation(s)
- Andrew Creadore
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA 02115 USA ,grid.189504.10000 0004 1936 7558Boston University School of Medicine, Boston, MA USA
| | - Priya Manjaly
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA 02115 USA ,grid.189504.10000 0004 1936 7558Boston University School of Medicine, Boston, MA USA
| | - Elizabeth Tkachenko
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA 02115 USA
| | - David G. Li
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA 02115 USA
| | - Benjamin Kaffenberger
- grid.412332.50000 0001 1545 0811Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Kanade Shinkai
- grid.266102.10000 0001 2297 6811Department of Dermatology, University of California, San Francisco, CA USA
| | - Misha Rosenbach
- grid.25879.310000 0004 1936 8972Department of Dermatology, University of Pennsylvania, Philadelphia, PA USA
| | - Cara Joyce
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA 02115 USA
| | - Arash Mostaghimi
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA 02115 USA
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8
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Wells A, Harmel A, Smith KN, Beers P, Qiu Y, Datta S, Schoch JJ, De Benedetto A, Longo I, Motaparthi K. Impact of Skin Biopsy and Clinical-Pathologic Correlation in Dermatology Inpatient Consults. Cureus 2022; 14:e28534. [PMID: 36185900 PMCID: PMC9517953 DOI: 10.7759/cureus.28534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background While studies of hospital dermatology have demonstrated diagnostic discordance between primary teams and dermatology consultants, little is known about the impact of biopsy and clinical-pathologic correlation (CPC) in consultation. This study compares biopsy performance based on diagnostic discordance and evaluates the impact of CPC on the diagnosis. Methods This was a retrospective review of 376 dermatologic consultations at a single academic medical center between July 1, 2017, and June 27, 2018. Results Biopsy was significantly less likely to be performed when the diagnosis by the referring primary team was unspecified (p < 0.001). In 24 percent of cases, the diagnosis based on histopathology alone differed from the diagnosis reached by formal CPC consensus review with either potential or significant impact on management. Conclusion Dermatologists who perform inpatient consultations and rely on hospital-based pathology services may consider a consensus review for CPC. Requests to perform a biopsy may be interpreted as a request for diagnostic assistance rather than pressure to perform a procedure.
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9
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Mocharnuk J, Lockard T, Georgesen C, English JC. Inpatient Teledermatology: a Review. CURRENT DERMATOLOGY REPORTS 2022; 11:52-59. [PMID: 35402084 PMCID: PMC8976271 DOI: 10.1007/s13671-022-00360-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/22/2022]
Abstract
Purpose of Review Inpatient teledermatology is a rapidly growing field with significant potential to add value and streamline patient care. This review summarizes the current literature on inpatient teledermatology, primarily focusing on its diagnostic and clinical management utility as compared to live dermatologic evaluation. Recent Findings The COVID-19 pandemic has accelerated the adoption of inpatient teledermatology, which has been shown to be comparable to live hospitalist evaluation for triage, diagnosis, and management of hospitalized patients for a wide variety of conditions. Despite its comparative cost-effectiveness and recent changes in reimbursement practices, inpatient teledermatology still lacks sufficient reimbursement incentive for widespread implementation. Summary Inpatient teledermatology is an effective, efficient, accurate, and cost-effective means of managing the hospital burden of skin disease, especially in areas where access to dermatologic care is limited. It is essential that dermatologists and referring providers comprehend the use and potential pitfalls of inpatient teledermatology to effectively incorporate it into hospital practice.
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10
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Adapting to the Challenge of Hospital-Based Care: The Evolving Role of Gastroenterology Hospitalists. Am J Gastroenterol 2022; 117:361-363. [PMID: 34904965 DOI: 10.14309/ajg.0000000000001585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
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11
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Kern-Goldberger AS, Money NM, Gerber JS, Bonafide CP. Inpatient Subspecialty Consultations: A New Target for High-Value Pediatric Hospital Care? Hosp Pediatr 2021:hpeds.2021-006165. [PMID: 34732510 DOI: 10.1542/hpeds.2021-006165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Nathan M Money
- Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Jeffrey S Gerber
- Center for Pediatric Clinical Effectiveness
- Division of Infectious Diseases
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher P Bonafide
- Section of Pediatric Hospital Medicine
- Center for Pediatric Clinical Effectiveness
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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12
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Puri P, Wiggins M, Yousif M, Pollock BD, Fox LP, Rosenbach M, Pittelkow MR, Mangold AR. Evaluating the potential cost savings from inpatient dermatology consultations. J Eur Acad Dermatol Venereol 2021; 35:e936-e938. [PMID: 34374133 DOI: 10.1111/jdv.17595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- P Puri
- Mayo Clinic, Scottsdale, AZ, USA
| | | | - M Yousif
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | - L P Fox
- University of California San Francisco, San Francisco, CA, USA
| | - M Rosenbach
- University of Pennsylvania, Philadelphia, PA, USA
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13
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Gonçalves Ferreira I. Hospital dermatology: an emerging subspecialty and its contributions to medical care. Int J Dermatol 2020; 59:e468-e470. [DOI: 10.1111/ijd.15212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Iago Gonçalves Ferreira
- Federal University of Health Sciences of Porto Alegre Porto Alegre Brazil
- Santa Casa de Misericórdia of Porto Alegre Porto Alegre Brazil
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14
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Faletsky A, Han JJ, Mostaghimi A. Inpatient Dermatology Best Practice Strategies for Educating and Relaying Findings to Colleagues. CURRENT DERMATOLOGY REPORTS 2020; 9:256-260. [PMID: 33133770 PMCID: PMC7592134 DOI: 10.1007/s13671-020-00317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
Purpose of Review This review examines the role of education and relaying findings to non-dermatologist colleagues when performing inpatient dermatology consults. We highlight best practices for communication and education. Recent Findings Non-dermatologists receive minimal training on the diagnosis and the management of skin conditions. Efforts to teach dermatology in the inpatient setting via traditional didactics have been met with limited success, and hospitalists have indicated a desire to learn from specialists. Incorporating education into standard consultation practices including the note, one-on-one communication, and bedside rounds can efficiently improve teaching and patient care. Summary Our key principles of consultation emphasize communication, use of pre-existing components of a consultation to teach, and close follow-up. Inpatient dermatologists can implement these simple but effective measures to encourage education and communication with primary teams for both in-person and telehealth consults.
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Affiliation(s)
- Adam Faletsky
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115 USA.,School of Medicine, Tufts University, Boston, MA USA
| | - Jane J Han
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115 USA.,Stritch School of Medicine, Loyola University Chicago, Maywood, IL USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115 USA
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15
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Fayne R, Castillo D, Sanchez N, Burroway B, Nanda S, De Bedout V, Stratman S, Rosen J, Darwin E, Nagrani N, Gonzalez A, Paul S, Maderal A, Elgart G, Kirsner R, Nichols A. Dermatology consultation service at a large metropolitan hospital system serving minority populations. J Eur Acad Dermatol Venereol 2020; 34:2120-2126. [DOI: 10.1111/jdv.16565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- R. Fayne
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - D.E. Castillo
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - N. Sanchez
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - B. Burroway
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - S. Nanda
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - V. De Bedout
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - S. Stratman
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - J. Rosen
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - E. Darwin
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - N. Nagrani
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - A. Gonzalez
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - S. Paul
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - A. Maderal
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - G. Elgart
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - R. Kirsner
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - A. Nichols
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
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16
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Ellis A, Billings SD, Khanna U, Warren CB, Piliang M, Vij A, Ko JS, Bergfeld WF, Fernandez AP. Diagnoses of hospitalized patients with skin abnormalities prompting biopsy by consulting dermatologists: A 3-year review from a tertiary care center. J Cutan Pathol 2019; 47:346-356. [PMID: 31845375 PMCID: PMC9291190 DOI: 10.1111/cup.13628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022]
Abstract
Background Dermatologists play an important role in diagnosing and managing hospitalized patients with cutaneous abnormalities. Skin biopsies remain an indispensable tool for aiding dermatologists in accurate diagnosis and treatment. We aimed to determine the range of conditions, and the most common conditions, prompting skin biopsy by dermatology hospital consultation (HCON) services to aid in evaluation of hospitalized patients. Methods All hospitalized patients seen by a single tertiary care center dermatology HCON service between 2015 and 2018 who had associated skin biopsies were identified. Histologic features and clinical diagnoses of each patient were classified into 13 histologic reaction pattern categories. Results Eight hundred and thirty one inpatients evaluated by our dermatology HCON service had 914 skin biopsies. The most frequent diagnostic categories prompting biopsy were vasculopathic (17.6%), interface dermatitis (16.5%), infectious (12.6%), and spongiotic dermatitis (10.9%). The most frequent diagnostic categories included drug reaction (13.2%), leukocytoclastic vasculitis (8.5%), skin cancer (5.4%), graft‐vs‐host disease (3.5%), connective tissue disease (3.3%), and calciphylaxis (3.0%). Conclusion Our study suggests a variety of serious diseases affecting inpatients prompts biopsy by dermatology consultation services. Educational curricula for dermatology and pathology residents, fellows, and staff designed with these data may enhance knowledge that improves the quality of inpatient dermatology care.
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Affiliation(s)
- Ariana Ellis
- Northeast Ohio Medical University College of Medicine, Rootstown, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Steven D Billings
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Urmi Khanna
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | | | - Melissa Piliang
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Alok Vij
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer S Ko
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Wilma F Bergfeld
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Anthony P Fernandez
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio
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17
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Georgesen C, Karim SA, Liu R, Moorhead A, Falo LD, English JC. Inpatient eDermatology (Teledermatology) Can Help Meet the Demand for Inpatient Skin Disease. Telemed J E Health 2019; 26:872-878. [PMID: 31663822 DOI: 10.1089/tmj.2019.0147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Currently, the number of inpatient dermatology providers cannot meet the overall burden of inpatient skin disease in the United States. Introduction: We seek to determine whether inpatient eDermatology can meet the need for inpatient skin disease in hospitals without access to a dermatology hospitalist. Methods: This retrospective cohort study reviewed inpatient eDermatology consults at the University of Pittsburgh eDermatology Consult Service between July 1, 2014 and June 30, 2018. This included a diverse group of 1,320 patients admitted to 10 different community hospitals. Study data were reviewed for demographics, diagnostic impressions, time to discharge, and diagnostic discordance between referring and consultant physicians. Results: Forty percent of inpatient eDermatology consults were admitted with a primary dermatologic diagnosis. Referring diagnosis most commonly was rash not otherwise specified. eDermatology consulting impressions, conversely, were specific and varied. Ninety-one percent of patients received a consultant impression by the end of day, or within 8 hours. Overall, 89.3% of patients with a referring diagnosis of "cellulitis" were given a different diagnosis by the consultant. Discussion: Although this study lacked concordance data to compare the Inpatient eDermatologist with a live Inpatient Dermatologist, overall, eDermatology consultants were able to provide rapid consult recommendations that aided patient management. Conclusions: Inpatient eDermatology appears to be an effective medium to provide dermatologic care to patients at hospitals without a dermatology presence. This delivery of health care can help prevent misdiagnosis, unnecessary costs, and inappropriate systemic therapies.
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Affiliation(s)
- Corey Georgesen
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sabrina A Karim
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rebecca Liu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Autumn Moorhead
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Louis D Falo
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pennsylvania, USA.,Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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