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Mansilla-Polo M, Navarro-Blanco F, Martín-Torregrosa D, Botella-Estrada R. Dermatologic Consultations for Patients Hospitalized in Non-Dermatologic Wards: Results of a 384-Patient Cross-Sectional Study From a Tertiary Referral Hospital. ACTAS DERMO-SIFILIOGRAFICAS 2023:S0001-7310(23)01007-4. [PMID: 38159838 DOI: 10.1016/j.ad.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- M Mansilla-Polo
- Dermatology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
| | - F Navarro-Blanco
- Dermatology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - D Martín-Torregrosa
- Dermatology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - R Botella-Estrada
- Dermatology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain; Faculty of Medicine, Universidad de Valencia, Valencia, Spain
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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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Vinay K, Thakur V, Choudhary R, Dev A, Chatterjee D, Handa S. A Retrospective Study to Evaluate the Impact of In-Patient Dermatological Consultations on Diagnostic Accuracy in a Tertiary Care Setting. Indian Dermatol Online J 2021; 12:417-422. [PMID: 34211908 PMCID: PMC8202492 DOI: 10.4103/idoj.idoj_555_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/25/2020] [Accepted: 09/24/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Dermatology is primarily an outpatient specialty. However, dermatology consultations play an important role in care of inpatients. Data on inpatient dermatological consultations in tertiary care settings is limited. Objectives: To evaluate clinical characteristics of inpatient dermatological consultations and effect on clinical outcomes in a tertiary care setting. Methods: This was a single-center retrospective study where the records of all dermatological consultations for patients admitted under various specialties, emergency services, and intensive care units (ICU) at our tertiary care institute over 2 years period were reviewed. The details of patients, primary care unit, dermatological complaints, diagnosis, investigations performed, treatment given, and follow-up were recorded and analyzed. Results: Total of 1717 dermatologic consultations (1000 males) were recorded, with mean age of study population being 33.6 ± 21.6 years (median - 32 years). Out of total 1717 patients, 136 (7.9%), 321 (18.7%), 1135 (66.1%), and 125 (7.3%) patients were infants, children, adolescents, adults, and elderly, respectively. The most frequent diagnostic group was infective diseases (586; 34.1%) followed by inflammatory diseases (442; 25.7%), mucocutaneous adverse drug reactions (160; 9.3%), and autoimmune diseases (65; 3.8%). Primary team's diagnosis was concordant with the dermatology consultation in 1112 (64.8%) patients and discordant observations were recorded in 605 patients (35.2%). Most discordant dermatological diagnoses included inflammatory disorders such as lichen planus, atopic dermatitis, bullous pemphigoid; mechanical disorders; nutritional deficiency disorders, and benign neoplasms. Conclusion: Common skin conditions account for a large majority of dermatologic consultations in a hospital setting. Inpatient dermatology consultations improve the diagnostic accuracy.
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Affiliation(s)
- Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Thakur
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajat Choudhary
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anubha Dev
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Pereira A, Porro A, Seque C, Pasin V, Tomimori J. Inpatient Dermatology Consultations in Renal Transplant Recipients. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pereira AR, Porro AM, Seque CA, Pasin VP, Tomimori J. Inpatient Dermatology Consultations in Renal Transplant Recipients. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:900-907. [PMID: 30360884 DOI: 10.1016/j.ad.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/03/2018] [Accepted: 07/15/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Renal transplant recipients (RTR), which are an increasing population, frequently suffer from post-transplant dermatological complications. Despite the well-established role of dermatologists in the outpatient care of these patients, no previous studies were found concerning dermatology consultations for hospitalized RTR. OBJECTIVES To investigate the epidemiology of dermatological conditions presented by RTR during hospitalization and assess the impact of dermatology consultations performed in the hospital setting. METHODS Dermatology consultations requested for RTR admitted at a kidney transplantation referral hospital in Brazil over 36 consecutive months were retrospectively included. RESULTS 176 consultations were included. Infectious dermatoses prevailed (52.3%), followed by inflammatory diseases (14.2%), neoplasms (12.5%) and drug reactions (8.5%). Diagnostic agreement between requesting and consulting teams was 38.1%. Most consultations were motivated by common dermatological conditions, unrelated to admission diagnosis. There were some differences in comparison to previous studies including general inpatients, such as: larger proportion of infectious dermatoses and neoplasms, smaller proportion of inflammatory diseases, higher percentage of patients submitted to skin biopsy, smaller proportion of consultations managed with a single visit and higher probability of a systemic treatment being recommended in this population. CONCLUSION Hospitalized RTR present distinct dermatological epidemiology and higher level of complexity, when compared to studies including general inpatients. Dermatology interventions during hospitalization may be beneficial in the multidisciplinary care of these patients, either contributing to the investigation of systemic conditions or providing relief for cutaneous comorbidities.
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Affiliation(s)
- A R Pereira
- Servicio de Dermatología, Universidad Federal de São Paulo, Sao Paulo, Brasil
| | - A M Porro
- Servicio de Dermatología, Universidad Federal de São Paulo, Sao Paulo, Brasil.
| | - C A Seque
- Servicio de Dermatología, Universidad Federal de São Paulo, Sao Paulo, Brasil
| | - V P Pasin
- Servicio de Dermatología, Universidad Federal de São Paulo, Sao Paulo, Brasil
| | - J Tomimori
- Servicio de Dermatología, Universidad Federal de São Paulo, Sao Paulo, Brasil
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Centkowski SM, Lipoff JB. Inpatient dermatology consultations: Motivation and practice of requesting providers. J Am Acad Dermatol 2017; 77:1173-1174.e3. [DOI: 10.1016/j.jaad.2017.06.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 10/18/2022]
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Balai M, Gupta LK, Khare AK, Mittal A, Mehta S, Bharti G. Pattern of inpatient referrals to dermatology at a tertiary care centre of South Rajasthan. Indian Dermatol Online J 2017; 8:25-28. [PMID: 28217467 PMCID: PMC5297265 DOI: 10.4103/2229-5178.198759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Dermatologists besides providing service to patients in the outdoors, also play a vital role in the care of inpatients admitted to dermatology unit and other departments. Aims: The aim of this study was to evaluate the pattern of referrals sent to the dermatology department by other departments. Materials and Methods: The study included all inpatients referred to dermatology department of a tertiary care centre of South Rajasthan during a 5-year period from October 2008 to September 2013. Results: A total of 1560 consultations with 1603 diagnoses were recorded. Most (770; 49.3%) consultations were received from internal medicine, followed by surgery (177; 11.3%), pediatrics (104; 6.7%), psychiatry (86; 5.5%) and gynecology (69; 4.4%) wards. Infectious skin diseases were most common (29.7%) followed by eczema (12.0%) and drug reactions (9.0%). Conclusion: Dermatology referrals can enhance the dermatological knowledge of non-dermatologists to diagnose and manage common dermatoses thus improving overall patient care.
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Affiliation(s)
- Manisha Balai
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Lalit K Gupta
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Ashok K Khare
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Asit Mittal
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Sharad Mehta
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Garima Bharti
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
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Galimberti F, Guren L, Fernandez AP, Sood A. Dermatology consultations significantly contribute quality to care of hospitalized patients: a prospective study of dermatology inpatient consults at a tertiary care center. Int J Dermatol 2016; 55:e547-51. [DOI: 10.1111/ijd.13327] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/16/2016] [Accepted: 02/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Fabrizio Galimberti
- Cleveland Clinic Lerner College of Medicine; Cleveland Clinic; Cleveland OH USA
| | - Lauren Guren
- Department of Dermatology; Cleveland Clinic; Cleveland OH USA
| | - Anthony P. Fernandez
- Department of Dermatology; Cleveland Clinic; Cleveland OH USA
- Department of Pathology; Cleveland Clinic; Cleveland OH USA
| | - Apra Sood
- Department of Dermatology; Cleveland Clinic; Cleveland OH USA
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Pediatric dermatology inpatient consultations: a retrospective study. Indian J Pediatr 2015; 82:541-4. [PMID: 25640068 DOI: 10.1007/s12098-015-1697-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe the profile of inpatient consultations seen in department of pediatric dermatology at a tertiary care children's hospital. METHODS The authors performed a retrospective review of all pediatric dermatology inpatient consultation data from medical record section over a period of 42 mo from January 2010 through June 2013. All children 18 y and below were included in the study. RESULTS A total of 486 inpatient consultation services were given by pediatric dermatology department. About 124 (25.5 %) of consultations were in the age group of infancy followed by 103 (21.1 %) consultations in the school going age children. Most frequent consultation request was from general pediatrics (49.4 %) followed by pediatric intensive care (37.9 %). The most common diagnostic categories included cutaneous infection (115, 23.7 %), emergency skin conditions (62, 12.8 %), genodermatosis (58, 11.9 %) and skin disorders secondary to systemic illness (55, 11.3 %). CONCLUSIONS This study highlights the spectrum of conditions that clinicians must be aware that can be seen in general pediatric wards and intensive care unit. This study also highlights the role of pediatric dermatologist in giving care to hospitalized children.
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Lee J, Hwang SH, Park JH, Kim WS. Dermatological conditions in patients with brain damage. DERMATOL SIN 2014. [DOI: 10.1016/j.dsi.2013.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mashayekhi S, Hajhosseiny R. Dermatology, an interdisciplinary approach between community and hospital care. JRSM SHORT REPORTS 2013; 4:1-4. [PMID: 23885301 PMCID: PMC3704063 DOI: 10.1177/2042533313486641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Skin lesions are extremely common, with 54% of the UK population being affected by skin disease annually. As such, dermatological conditions can be brought to light following admission to hospital for different underlying conditions, with 57% of the dermatological diagnoses made on the hospital wards, unrelated to previous patient history or reasons for admission. The role of the dermatologist is therefore comprehensive and inherently important in the hospital. General practitioners play an integral role in managing skin conditions in the community, with up to 24% of consultations relating to skin disease, referring patients to dermatology mainly for the management of more complex conditions, and diagnosis of certain skin lesions. It is therefore essential to further analyse these roles and to better understand the extent of inpatient and outpatient activity to better plan the provision of dermatological services whether in the community, or in the hospital.
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Affiliation(s)
- Soudeh Mashayekhi
- Department of Primary Care & Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London W6 8RP, UK
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McMahon P, Goddard D, Frieden IJ. Pediatric dermatology inpatient consultations: A retrospective study of 427 cases. J Am Acad Dermatol 2013; 68:926-31. [DOI: 10.1016/j.jaad.2012.12.949] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 12/03/2012] [Accepted: 12/05/2012] [Indexed: 11/29/2022]
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de Paula Samorano-Lima L, Quitério LM, Sanches JA, Neto CF. Inpatient dermatology: profile of patients and characteristics of admissions to a tertiary dermatology inpatient unit in São Paulo, Brazil. Int J Dermatol 2013; 53:685-91. [PMID: 23675752 DOI: 10.1111/j.1365-4632.2012.05818.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dermatology is primarily an outpatient clinical and surgical specialty, but substantial numbers of patients are admitted to hospital for inpatient treatment in dermatology wards. METHODS We performed a retrospective study of patients admitted to dermatology beds between September 1, 2002, and September 30, 2010. Patient data were analyzed for age, gender, ethnicity, length of stay (LoS), dermatologic disease, comorbidities, hospital-acquired infection (HAI), transfer to the intensive care unit (ICU), and mortality. RESULTS A total of 3308 patients admitted during this 8-year period were identified for analysis. The most frequent admissions were for eczema/dermatitis (17.5%) and cutaneous infections (15.9%). The mean LoS was 13.0 days. The mean ± standard deviation (SD) number of comorbidities per patient was 1.0 ± 1.2, among the most frequent of which were hypertension and diabetes mellitus. The rate of HAI was 6.2%; bloodstream infection was regarded as the most commonly acquired type and Staphylococcus aureus as the infectious agent most commonly found in culture. Of the patients admitted, 3.7% were transferred to the ICU and 2.5% died. In these latter two groups, the most common dermatologic diagnoses were immunobullous diseases, and the mean hospital LoS and rate of HAI were higher than in the total admissions cohort. CONCLUSIONS Higher value should be placed on dermatology inpatient services in order to expand the availability of dermatology beds, mainly in tertiary hospitals, in view of the potentially high severity of the dermatologic diseases found in many patients referred to this type of service.
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el-Azhary R, Weenig RH, Gibson LE. The dermatology hospitalist: creating value by rapid clinical pathologic correlation in a patient-centered care model. Int J Dermatol 2012; 51:1461-6. [DOI: 10.1111/j.1365-4632.2011.05412.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tay LK, Lee HY, Thirumoorthy T, Pang SM. Dermatology referrals in an East Asian tertiary hospital: a need for inpatient medical dermatology. Clin Exp Dermatol 2010; 36:129-34. [PMID: 20738321 DOI: 10.1111/j.1365-2230.2010.03923.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Within hospitals, there is a need for dermatological expertise, as hospitalized patients have a wider spectrum of severe and serious dermatological conditions, associated with significant morbidity. AIM To characterize the patient profile and referral pattern of inpatient dermatology consultations, and to evaluate the diagnostic accuracy of non-dermatologists. METHODS This was a retrospective study reviewing all inpatient referrals for dermatology consultations during a 1-year period from July 2005 to June 2006 (inclusive), at the largest multi-disciplinary tertiary hospital in Singapore. RESULTS Of the 731 referrals made for dermatology consultations, 26.9% of patients had ≥ 3 important underlying comorbidities. Eczema/dermatitis (33.1%; n = 242) and cutaneous infections (23.4%; n = 171) accounted for over half of the dermatological consultations, followed by cutaneous adverse drug reactions (12.3%; n = 90). The provisional diagnoses of the referring doctors agreed with the final diagnoses confirmed by dermatologists in only 30.2% of all referrals; incorrect diagnoses were made in 35.2% of cases, and no provisional diagnoses were made in the remaining 34.6% of cases. Most misdiagnosed skin diseases were in fact common dermatoses (such as eczemas, cutaneous infections, drug rash) that required only standard treatment. CONCLUSION Our study reiterates the importance of inpatient medical dermatology in terms of both service and education. There should be continual efforts to ensure that dermatologists have the highest level of training and experience in medical dermatology, to provide collaborative optimum care for hospitalized patients with dermatological diseases.
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Affiliation(s)
- L K Tay
- Department of Dermatology, Singapore General Hospital, Singapore City, Singapore.
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Mancusi S, Festa Neto C. Inpatient dermatological consultations in a university hospital. Clinics (Sao Paulo) 2010; 65:851-5. [PMID: 21049212 PMCID: PMC2954736 DOI: 10.1590/s1807-59322010000900007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 06/15/2010] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Dermatology is primarily an outpatient specialty, but it also plays an important role in the care of inpatients. METHODS We conducted a prospective study that recorded data from inpatient dermatology consultation request forms over a period of four months. The study evaluated 313 requests that led to 566 visits, 86 biopsies, 35 laboratory exams, 41 direct microscopic studies, 18 direct immunofluorescence analyses, 14 skin cultures and a few other exams. RESULTS The most frequent requesting service was internal medicine (24%), followed by neurology (12%), cardiology (11%), infectious diseases and pediatrics (8% each) and psychiatry and general surgery (6% each). The most frequent diagnostic groups were infectious diseases (25%, divided into fungal infections (13%), bacterial infections (7%) and viral infections (5%)), eczemas (15%) and drug reactions (14%). To our knowledge, this is the first study to attempt to evaluate the impact of the consultations by asking multiple-choice questions that were analyzed by the authors. In 31% of the cases, the consultation was considered extremely relevant because it aided in managing the disease that led to admission or treated a potentially severe dermatological disease. In 58% of the cases, the consultation was considered important because it facilitated diagnosis and/or treatment of a dermatological disease that was unrelated to the reason for admission.
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Affiliation(s)
- Suzana Mancusi
- Dermatology Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil.
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Hospital consultations: Time to address an unmet need? J Am Acad Dermatol 2009; 60:308-11. [DOI: 10.1016/j.jaad.2008.10.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 09/25/2008] [Accepted: 10/06/2008] [Indexed: 11/20/2022]
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England RW, Ho TC, Napoli DC, Quinn JM. Inpatient consultation of allergy/immunology in a tertiary care setting. Ann Allergy Asthma Immunol 2003; 90:393-7. [PMID: 12722960 DOI: 10.1016/s1081-1206(10)61822-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few studies examine the referral patterns for allergy/immunology (A/I) inpatient consultation. OBJECTIVE The purpose of this study was to examine the primary reason and trends for A/I inpatient consultation to improve fellowship training. METHODS We performed a retrospective chart review of all inpatient A/I consults from July 1, 1987 to June 30, 2001 to determine the primary reason for consultation. We also reviewed trends in the total admissions and the average daily patient load compared with A/I consultation. RESULTS A total of 1,284 A/I inpatient consults were reviewed. Thirty-six percent (460 of 1,284) of inpatient consults were for evaluation of adverse drug reactions, 21% (270 of 1,284) asthma, 21% (272 of 1,284) miscellaneous reasons, 8% (109 of 1,284) possible immunodeficiency, 7% (93 of 1,284) angioedema/urticaria, and 6% (80 of 1,284) anaphylaxis. Our results demonstrated a fall in inpatient consults that correlated with a similar fall in total hospital admissions. The ratio of A/I inpatient consults to total admissions remained constant. Additionally, the ratio of A/I consults to average daily patient load increased over the study period. There was a decrease in asthma and adverse drug reaction consults, whereas immunodeficiency and anaphylaxis referrals remained stable. CONCLUSIONS Identifying the most common reasons for inpatient consultation provides a guide for the education of A/I fellows and primary care residents. Inpatient consultation continues to play a crucial role in A/I training as it provides unique opportunities to evaluate serious life threatening diseases. An unchanged trend of consultation for immunodeficiency and anaphylaxis reaffirms the importance of the allergist/immunologist as a valuable resource for inpatient consultation.
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Affiliation(s)
- Ronald W England
- Department of Allergy/Immunology, Wilford Hall Medical Center, Lackland AFB, Texas 78236-5300, USA.
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Abstract
We undertook the current survey-based study to assess clinicians' views on the determinants of effective inpatient consultation and the existing process of inpatient consultation at the Cleveland Clinic Hospital. A 25-question survey developed for this study using Likert scale responses was completed by 181 (of 404 eligible addressees, a 45% response rate) members of the Cleveland Clinic staff in the divisions of medicine, surgery, and pediatrics. Ratings of the overall value of inpatient consultation reflected moderate satisfaction (mean 6.9 of possible 10). Types of consults that were most valued were those requesting a procedure and those seeking assistance in establishing a diagnosis and in interpreting data. Features deemed most important in making a consult excellent were legibility of the consultant's note, timeliness of the response (i.e., within 24 hours), and direct communication of the consult question. The data showed a trend indicating that physicians regarded the value of direct physician-to-physician communication more highly than they personally practiced such direct communication when requesting a consult. Study findings indicate the opportunity to improve the process of inpatient consultation by implementing measures that enhance direct physician-to-physician communication about the consult, ensure timeliness, facilitate identification of the appropriate consultants, and allow easier auditing. We propose a novel process for requesting inpatient consultations that extends currently available hospital information systems but offers a process improvement that warrants development.
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Affiliation(s)
- James K Stoller
- Section of Respiratory Therapy, Department of Pulmonary and Critical Care Medicine, Division of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
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