Inpatient dermatology referrals: what is the burden? A retrospective review of 14 years of dermatology inpatient referrals.

Background: The lack of dermatological knowledge by nondermatologists is exposed by the increasing number of requests made for inpatient dermatological consultations. Patients have been commenced on inappropriate treatment because of poor dermatology training.

Objectives: To determine the burden and accuracy of inpatient dermatology referrals.

Methods: A retrospective cohort study using paper inpatient dermatology referrals from one health board (Cwm Taf Morgannwg University Health Board, Wales, UK) between June 2007 and July 2021. Data analysis included timing of referrals, referring specialty, diagnosis and treatment. Descriptive statistics, using Excel, were used for analyses.

Results: The average number of referrals per year was 106 (range 79-166). The most frequent day of referral was Monday (26%). Most referrals were from medical teams (73%).Differential diagnosis was suggested by the referring team in 59% of referrals. In only 29% of referrals did the dermatology team agree with the differential diagnosis. There was a discrepancy in the correctness of diagnosis in all categories; however, paediatricians were most likely to offer a correct differential (44%). In 44% of referrals, treatment was commenced by the referring team, most commonly antibiotics.

Conclusions: There is an extra burden on dermatology teams to cover inpatients. Our figures highlight two important issues. Firstly, the need for better dermatological education in medical schools to improve diagnostic accuracy and management of conditions. Secondly, the need for an inpatient dermatology service to review inpatient referrals and advise in the diagnosis and management of dermatology cases on the wards and to protect the service from being uncoupled from the main hospital.