Inpatient Consultative Dermatology

Hospital Dermatology: analysis of dermatological consultations in a tertiary teaching hospital

BACKGROUND

In hospital settings, dermatology can offer substantial clinical support for the diagnosis and management of skin conditions, reducing morbidity and mortality. Thus, the study aimed to analyze the profile of referrals and consultations performed by the Dermatology Service of the Santa Casa de Misericordia de Porto Alegre, from August 2018 to January 2020.

METHODS

This study is descriptive, quantitative, and retrospective, conducted through data collection and review of medical records and referrals. The variables included were clinical data of referrals, in-patients profiles, dermatological diagnoses, complementary exams, therapeutic conduct, and recommended follow-ups.

RESULTS

A total of 1020 referrals were analyzed, which resulted in 641 consultations (328 men, 313 women). The most prevalent skin disease groups were 'Dermatitis and Eczema' (33.1%) and 'Other infectious skin diseases (21.8%), while the most frequent ICD-10 were 'Drug eruptions - L27' (9.9%) and 'Other and unspecified dermatitis - L30' (6.6%). Corticoids were the most recommended treatments (27.7%), followed by antifungals (13.1%). 'Consultation Discharge' (44%) and 'Outpatient' Dermatology follow-up (27%) were the most frequent causes for ending consultation.

STUDY LIMITATIONS

Among the study limitations, the authors highlight its retrospective nature, with data analysis based on referrals and medical records, which may present inaccurate or incomplete information. In addition to this, the study may demonstrate a certain degree of subjectivity due to the review and interpretation process conducted by the researchers. However, the definition of objective criteria based on previous studies attenuates such possible bias. Furthermore, considering that the Dermatology teams are composed of a preceptor dermatologist and residents, the established diagnoses were not submitted to third-party verification, except in the cases of skin biopsies and cultures. Thus, the professional's experience and skills may have influenced the dermatological diagnoses.

CONCLUSIONS

These findings underlie the importance of Dermatology in hospital assistance, contributing to the management of a wide range of skin conditions.

Patterns of Dermatological Diseases in Inpatient Consultations at King Abdulaziz Medical City, Jeddah, Saudi Arabia: An Underexploited Opportunity for Dermatology Clinical Training

Background

Inpatient dermatological care represents an opportunity to improve dermatological care among the population as well as to enhance clinical exposure for residents and medical trainees.

Objective

We conducted this study to analyze the pattern of dermatological conditions encountered in inpatient settings and the modalities of management at a tertiary care hospital.

Method

We retrospectively reviewed and analyzed electronic records of all inpatient consultations carried out by the dermatology consultants and specialists between January 1, 2020 and December 31, 2020. Demographic and specific and non-specific clinical data were collected and analyzed by dividing the skin disorders and treatments into categories, where relevant.

Result

Five hundred and seventy-one inpatient dermatological consultations were carried out, involving 453 patients. Older age groups were predominant, including 50-70 years (27.4%) and >70 years (21.0%). The female to male ratio was 1.19. The majority of the consultations (388/571, 68.1%) were requested from the adult medical wards; internal medicine (23.8%), hematology (13.7%), and oncology (9.1%) being the most frequented wards. A biopsy was carried out in 57 (10.0%) of the cases. The most prevalent diagnoses included dermatitis (16.3%), intertrigo (8.1%), and xerosis (6.8%). Besides, 10 cases of skin cancer or metastasis were diagnosed by the dermatologist. The diagnosed skin condition was drug-induced in 57 (10.0%) of the cases, and nine of them were due to chemotherapy. Pharmaceutical treatments consisted of more frequently used corticosteroids (51.5%), antibiotics (36.4%), and antifungal agents (20.8%), with the majority of these by topical route.

Conclusion

A broad range of dermatological conditions are diagnosed in our inpatient setting, representing a good educational opportunity for trainee dermatologists. The implementation of digital photography could enhance the documentation of dermatological conditions, which would have beneficial effects on both care quality and education.

Utilization and Cost of Inpatient Dermatologic Procedures: A Cross-sectional Analysis

Knowledge surrounding inpatient dermatologic procedure costs is limited; therefore to learn more, we performed a cross-sectional analysis of dermatologic procedures contained in a publicly available Washington State Comprehensive Hospital Abstract Reporting System database from 2014. Dermatologic procedure utilization and cost were evaluated based on several parameters including demographics, length of hospital stay, payments, and payers. SAS 9.4 was used for the analysis. A total of 14,768 patients underwent dermatologic procedures in 2014 and 81.0% were white. The average age was 53 years (SD = 0.17), and the average payment for all patients who underwent dermatologic procedures was $85,059.48 (SD = $1,284.34). The average hospital length of stay was 8.91 days (SD = 0.07). The most common admission type was elective (66.2%), the most common admit source was a non-healthcare facility point of origin (78.2%), the most common primary payer was Medicare (36.2%), and the most common procedure was incision and drainage of skin and subcutaneous tissue (26.5%), followed by closure of skin and subcutaneous tissue of other sites (20%). This analysis demonstrated that inpatient dermatologic procedures are a significant driver of inpatient health care costs, and it is critical to determine factors that increase inpatient costs related to dermatologic procedures in order to develop strategies for reducing healthcare costs.