PA18 Audit of direct booking of urgent dermatology slots by the emergency department

Abstract Children with skin disorders frequently present to emergency departments (EDs) with onward referral to dermatology. Recognizing the urgency of some presentations, and to minimize requests from ED for an immediate dermatology opinion, we created one dedicated ED slot on all consultant dermatology clinics, which was directly bookable by the ED. If the slot was unfilled it could be used for other urgent referrals. This system worked well over many years, but recently clinicians have noted long waits by ED patients. To analyse slot use, we undertook a retrospective audit from 1 April 2022 to 31 March 2023. We identified 219 appointments for 210 individuals. Twelve episodes, none of which were ED referrals, were excluded from analysis due to inadequate or erroneous data. The remaining 207 referrals were from ED (85, 41.1%), general practitioners (92, 44.4%), internal specialties (15, 7.2%), external hospitals (9, 4.3%) or our own department (6, 2.9%). The commonest non-ED referrals were melanocytic naevi (34, 27.9%), infantile haemangiomas (21, 17.2%) and eczema (18, 14.8%). The most frequent ED referrals were eczema flares (29%), infected eczema (15%) and ‘nonspecific rashes’ (12%). The median symptom duration was 4 weeks (range 1 day to several years). Treatment given in ED was considered appropriate in most cases (56%) but could not be assessed in 28% because of ED clinician diagnostic uncertainty. In 11% of cases, ED sought on-call dermatology advice before booking appointments. The median wait from referral to appointment was 2 weeks (range 0–7), with an attendance rate of 84.7%. In 20% of attendances, the problem had already resolved. The audit team’s assessment of referrals was that most were warranted, with further treatment commenced in 74.1% and ongoing clinic follow-up in nearly 75%. In conclusion, our work highlights that these outpatient slots designed for ED use were being utilized for other referrals, resulting in excessive waits by ED patients with urgent needs. This reflects outpatient waiting list pressures including 2-week-wait referrals. We propose to reinforce booking rules to the call centre and to reinstate regular dermatology teaching in ED to optimize urgent first-line management.