BT28 Analysis of a single practitioner’s teledermatology processing decisions in an established teledermatology service over a 12-month period

Abstract In our department, teledermatology has been the default referral pathway from general practice since August 2016. In the 12 months to August 2022, 19 995 teledermatology referrals were processed by 10 consultant dermatologists (8 whole-time equivalents). This analysis reviewed the diagnoses and outcomes of 2667 consecutive teledermatology referrals, processed by one of these consultants, with a special interest in skin cancer, over that 12-month period. Data collected from the National Clinical Patient Database included the initial teledermatology referral and response and, where appropriate, details of subsequent clinic attendance and histology reports. Duplicate referrals (n = 64) and referrals redirected to colleagues (n = 82) were excluded from the analysis. In total, 157 (6%) referrals were rejected by the teledermatologist, either because they were submitted without a photograph (n = 41), the photograph was inadequate (n = 78), the incorrect photo was attached (n = 3), the history was insufficient (n = 21) or there were other factors such as request for services not offered or advice had already been provided (n = 14). Overall, 1391 (52%) referrals were returned to the general practitioner with diagnosis and/or management advice, and 973 (36%) patients were accepted onto the dermatology waiting list for subsequent review in clinic. Of these, 155 were accepted to rule out melanoma. During the period of assessment, 632 of the patients who had been accepted onto the waiting list had been reviewed in clinic: 96 (72%) of those with a telediagnosis of basal cell carcinoma (BCC) were confirmed to have BCC, 61 (30%) of those with a telediagnosis of squamous cell carcinoma (SCC) were confirmed to have SCC, 16 (57%) of those with a telediagnosis of melanoma were confirmed to have melanoma, and of those accepted to rule out melanoma, 14 (9%) were confirmed to have melanoma. Teledermatology provides a ‘snapshot’ of a skin disease with limited clinical information and photographs. The teledermatologist must decide whether the information provided is adequate to make a confident diagnosis and management plan. Our analysis showed that most teledermatology referrals were considered adequate for the purpose, and just over one-third needed to be seen in clinic. It also demonstrated the superior diagnostic accuracy of face-to-face consultations over teledermatology. Teledermatology is an excellent tool for dermatology triage, and in this analysis it reduced the need for face-to-face consultations by 60%.