Summary

Public dermatology outpatient departments across Ireland were closed under the COVID-19 restrictions to free up hospital resources. This resulted in the cancellation and delay of thousands of outpatient appointments. Dermview Dermatology offered its technology services to the HSE and was invited to join its Framework agreement for national services. The local hospital’s dermatology patients were moved out of the hospital setting and appointments were carried out in local and regional DermView Clinics across Ireland. Its teledermatology service enabled consultant dermatologists to diagnose remotely and safely, with the most urgent cases being seen rapidly.

Method

With such long waiting times to access a consultant dermatologist, a rapid service that covered lesional dermatology was required. The hospital department leads, business managers and HSE were involved in the rollout. The goal was to rapidly reduce the waiting list and time for patients to access care. A guarantee of certain patient numbers to be diagnosed and discharged within a set time frame (250 per hospital per month) was given, as this was realistic and achievable for both the hospitals and Dermview. The hospital administration, GP and consultants’ teams were all part of the project build and design to ensure patient flows were correct and achievable. As soon as patients were transferred to Dermview, each was contacted with an appointment time. The hospitals always had full visibility of their patients’ status via Dermview’s technology platform. Safe systems were in place for the handover and hand back of patients, which were done digitally by shared access on the DermView secure platform. Results were measured for patients discharged weekly once the hospitals had agreed that care was completed.

Results

Out of a total of 1,606 patients the results were that 21.66% had skin cancer, 4.20% needed long-term care and 12.25% required a face-to-face appointment. Direct discharge with a prescription stood at 46.45%, while direct discharge where nothing was required was 15.44%. The early diagnosis of skin cancer meant these patients required far less invasive surgical procedures (3.8% were melanoma), resulting in lower costs to the health system.

This has led the hospitals to consider using the technology and service as a long-term method for clinical access to a consultant dermatology diagnosis. The process allows far quicker access for urgent lesional, and suspected skin cancer, patients.

Sustainability and Spread

A paper will be published covering the full results, time for care, surgery time and histology time, which will show the overall effectiveness of this high-end teledermatology system. Clear data sets and facts on the overall results are available. Other hospitals that did not take part have been given a full breakdown of the project and results per hospital. This has led them to ask for the same service and technology in their local department.