Summary

Leeds Teaching Hospitals instituted a new digital dermatology referral system, across three interacting hospital sites. This is the first UK dermatology department to utilise Patient Pass for referrals. The primary purpose was to improve patient care by enabling safe and efficient triage of inpatient dermatology referrals. The service allowed remote review during the COVID-19 pandemic, and increased the skills of registrar dermatologists in teledermatology. It is now a recognised part of the training curriculum, and an essential consultant dermatologist skill. The platform improved patient safety through early recognition of dermatological emergencies, and improved communication between dermatology and other specialties.

Method

The hospitals collaborated with Patient Pass, which is a secure, two-way messaging programme to promote efficiency of referrals and allow a full audit trail for information governance. Importantly, it had to be acceptable for inpatients with dermatology conditions, the dermatology team, and referrers. The goals were: to improve patient care by providing clear and efficient dermatology advice; to reduce nosocomial spread of COVID-19 by facilitating remote review where appropriate; earlier recognition of dermatological emergencies with alerts to urgent referrals; to educate dermatology registrars in teledermatology; to facilitate discussions between consultants and registrars; to improve the experience of the on-call dermatology registrar and clinic patients with fewer disruptive phone calls, and to improve communication between dermatology and other hospital specialties by including them in initial plans. The timeframe for project implementation was three months. The project involved a funding application, liaison with IT leads and collaboration with the Patient Pass CEO. First, information was gathered from dermatology registrars and those completing referrals via questionnaire. The outcomes were audited, including number of telephone referrals, interruptions to clinic, plus referrals requiring call-back. Discussions were held with IT, clinical leads, funding, as well as at dermatology service team and clinical governance meetings. The team worked with Patient Pass to create a dermatology-specific digital platform that would put patient safety paramount and include urgent referral flagging. A trial run was conducted with a service user assessment. When Patient Pass launched it was advertised via the staff intranet. Next, a re-audit was conducted within dermatology, and those referring, via a questionnaire. Future areas of work were outlined, including primary care referrals and the inclusion of photographs.

Results

The average number of referral calls over 10 weeks pre Patient Pass was 4.9 per day (5). Post Patient Pass this was 0.9 per day (1), or an 80% reduction. Interruptions to clinic pre Patient Pass were 2.3 per clinic. Post Patient Pass it was 0.6 per clinic, or a 75% reduction. The number of call-backs needed to request additional information pre Patient Pass were 2.1 per day, contrasting with the number post Patient Pass, which stood at 0.3 per day, or an 85% reduction. Regarding awareness of the dermatology referral system among other specialties, before the Patient Pass, 7 of 11 were confident of the referrals system. Post Patient Pass 9 out of 10 were confident of the referrals system. All 10 referrers questioned found this referral system easier to use than the previous one. There was also reduced transmission of COVID-19. While this was difficult to assess, the number of teledermatology consultations increased, so transmission was probably reduced. Overall this innovation will benefit patients with skin conditions by allowing access to efficient and accessible specialist advice.

Sustainability and Spread

Patient Pass was designed to improve communication between departments. It speeds up referrals and provides a full audit trail for information governance. It is a robust and transparent system and is already used by other hospital specialities. It can be integrated into the patient record and will have its own photographic app soon to make a more seamless process. It is scalable and the team is considering the inclusion of primary care referrals in the future. Funding has been provided for two years. Audits and feedback from service users are ongoing. The team would be happy to share the experience with other NHS trusts and support local district general hospitals in the region if they were to implement Patient Pass. Information has been disseminated internally via the intranet, and there are plans to collaborate with the Primary Cary Quality Improvement Network, which disseminates information and celebrates such initiatives.