Sage Journals: Discover world-class research

Abstract

Background

Dermatological conditions are commonly seen in the emergency department and inpatient wards. The ability to access dermatology on-call services improves the accuracy of diagnosis and management of common and sometimes life-threatening conditions. Limitations of dermatologist availability led to the suspension of the dermatology on-call service for 3 months in Ottawa, Canada.

Objectives

Our objective was to assess the impact of this call suspension on patient care and the need for a dermatology on-call service at our hospital, as perceived by nondermatologist physicians at our center.

Methods

A survey was sent to all departments at The Ottawa Hospital, addressed to staff physicians and residents. Participation was entirely voluntary. Descriptive statistics were used to analyze survey responses.

Results

A total of 105 physicians completed the survey including staff physicians (85%) and resident trainees (15%). The most represented specialties were emergency medicine (N = 21), general internal medicine (N = 19), nephrology (N = 17), neurology (N = 13), and plastic surgery (N = 13). Over half of the respondents felt that the lack of dermatology on-call service impacted the care of their patients by a moderate or great extent. Over half reported performing dermatology-related clinical work during the call suspension and two-thirds of these individuals reported feeling uncomfortable or very uncomfortable doing so. Most (94%) participants felt that an on-call dermatology service was useful and 57% deemed it essential.

Conclusion

Our survey results demonstrate a significant impact of the suspension of a dermatology on-call service, as perceived by nondermatologist physicians. Hospitals need to recognize the importance of on-call dermatology consultations and provide support for divisions to enable this service to continue.

Keywords

accessibility workforce inpatient dermatology on-call dermatology

Get full access to this article

View all access options for this article.

References

Arakaki

RY.

Strazzula

Woo

Kroshinsky

. The impact of dermatology consultation on diagnostic accuracy and antibiotic use among patients with suspected cellulitis seen at outpatient internal medicine offices: a randomized clinical trial. JAMA Dermatol. 2014;150(10):1056-1061.doi:10.1001/jamadermatol.2014.1085

http://www.ncbi.nlm.nih.gov/pubmed/25143179

Falanga

Schachner

LA.

Rae

et al. Dermatologic consultations in the hospital setting. Arch Dermatol. 1994;130(8):1022-1025.doi:10.1001/archderm.1994.01690080088013

http://www.ncbi.nlm.nih.gov/pubmed/8053699

Haynes

Ferrazza

Kupper

Qureshi

. Impact of specialist consultations on inpatient admissions for dermatology-specific and related DRGs. J Gen Intern Med. 2013;28(11):1477-1482.doi:10.1007/s11606-013-2440-2

http://www.ncbi.nlm.nih.gov/pubmed/23709404

Kroshinsky

Cotliar

Hughey

LC.

Shinkai

Fox

. Association of dermatology consultation with accuracy of cutaneous disorder diagnoses in hospitalized patients: a multicenter analysis. JAMA Dermatol. 2016;152(4):477-480.doi:10.1001/jamadermatol.2015.5098

http://www.ncbi.nlm.nih.gov/pubmed/26762199

Levell

NJ.

Wingfield

CG.

Garioch

. Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care. Br J Dermatol. 2011;164(6):1326-1328.doi:10.1111/j.1365-2133.2011.10275.x

http://www.ncbi.nlm.nih.gov/pubmed/21564054

Maza

Berbis

Gaudy-Marqueste

et al. Evaluation of dermatology consultations in a prospective multicenter study involving a French teaching hospital. Ann Dermatol Venereol. 2009;136(3):241-248.doi:10.1016/j.annder.2008.12.020

http://www.ncbi.nlm.nih.gov/pubmed/19328306

Strazzula

Cotliar

Fox

et al. Inpatient dermatology consultation AIDS diagnosis of cellulitis among hospitalized patients: a multi-institutional analysis. J Am Acad Dermatol. 2015;73(1):70-75.doi:10.1016/j.jaad.2014.11.012

http://www.ncbi.nlm.nih.gov/pubmed/26089048

Tracey

EH.

Forrestel

Rosenbach

Micheletti

. Inpatient dermatology consultation in patients with hematologic malignancies. J Am Acad Dermatol. 2016;75(4):835-836.doi:10.1016/j.jaad.2016.05.014

http://www.ncbi.nlm.nih.gov/pubmed/27646742

El-Azhary

Weenig

RH.

Gibson

. The dermatology hospitalist: creating value by rapid clinical pathologic correlation in a patient-centered care model. Int J Dermatol. 2012;51(12):1461-1466.doi:10.1111/j.1365-4632.2011.05412.x

http://www.ncbi.nlm.nih.gov/pubmed/22612758

10.

LN.

Garza-Mayers

AC.

St John

et al. Effect of dermatology consultation on outcomes for patients with presumed cellulitis: a randomized clinical trial. JAMA Dermatol. 2018;154(5):529-536.doi:10.1001/jamadermatol.2017.6196

http://www.ncbi.nlm.nih.gov/pubmed/29453872

11.

Milani-Nejad

Zhang

Kaffenberger

. Association of dermatology consultations with patient care outcomes in hospitalized patients with inflammatory skin diseases. JAMA Dermatol. 2017;153(6):523-528.doi:10.1001/jamadermatol.2016.6130

http://www.ncbi.nlm.nih.gov/pubmed/28296992

12.

DG.

Xia

FD.

Khosravi

et al. Outcomes of early dermatology consultation for inpatients diagnosed with cellulitis. JAMA Dermatol. 2018;154(5):537-543.doi:10.1001/jamadermatol.2017.6197

http://www.ncbi.nlm.nih.gov/pubmed/29453874

13.

Fox

LP.

Cotliar

Hughey

Kroshinsky

Shinkai

. Hospitalist dermatology. J Am Acad Dermatol. 2009;61(1):153-154.doi:10.1016/j.jaad.2009.03.018

http://www.ncbi.nlm.nih.gov/pubmed/19539858

14.

Micieli

Alhusayen

. Changes in the practice patterns and demographics of Ontario dermatologists. J Cutan Med Surg. 2018;22(4):390-399.doi:10.1177/1203475418762719

http://www.ncbi.nlm.nih.gov/pubmed/29519145

15.

Arnold

JD.

Yoon

Kirkorian

. The National burden of inpatient dermatology in adults. J Am Acad Dermatol. 2019;80(2):425-432.doi:10.1016/j.jaad.2018.06.070

http://www.ncbi.nlm.nih.gov/pubmed/30554891

16.

Storan

ER.

McEvoy

MT.

Wetter

et al. Experience of a year of adult Hospital dermatology consultations. Int J Dermatol. 2015;54(10):1150-1156.doi:10.1111/ijd.12555

http://www.ncbi.nlm.nih.gov/pubmed/25384904

17.

LN.

Kroshinsky

. Dermatology hospitalists: a multicenter survey study characterizing the infrastructure of consultative dermatology in select American hospitals. Int J Dermatol. 2018;57(5):553-558.doi:10.1111/ijd.13939

http://www.ncbi.nlm.nih.gov/pubmed/29468658

18.

Maguiness

Searles

GE.

From

Swiggum

. The Canadian Dermatology Workforce Survey: implications for the future of Canadian dermatology--who will be your skin expert? J Cutan Med Surg. 2004;8(3):141-147.doi:10.1007/s10227-004-0107-7

http://www.ncbi.nlm.nih.gov/pubmed/15578128

19.

Chow

EY.

Searles

. The amazing vanishing Canadian dermatologist: results from the 2006 Canadian dermatology association member survey. J Cutan Med Surg. 2010;14(2):71-79.doi:10.2310/7750.2010.09025

http://www.ncbi.nlm.nih.gov/pubmed/20338122

20.

Mydlarski

PR.

Parsons

LM.

Pierscianowski

et al. Dermatologic training and practice in Canada: a historical overview. J Cutan Med Surg. 2019;23(3):307-318.doi:10.1177/1203475419840630

http://www.ncbi.nlm.nih.gov/pubmed/30999785

21.

Royal College of Physicians and Surgeons of Canada . National Specialty Physicians Review. Royal College of Physicians and Surgeons of Canada; 1988.

22.

Glazer

AM.

Rigel

. Analysis of trends in geographic distribution of US dermatology workforce density. JAMA Dermatol. 2017;153(5):472-473.doi:10.1001/jamadermatol.2016.6032

http://www.ncbi.nlm.nih.gov/pubmed/28296988

23.

Suneja

Smith

ED.

Chen

GJ.

Zipperstein

KJ.

Fleischer

AB.

Feldman

. Waiting times to see a dermatologist are perceived as too long by dermatologists: implications for the dermatology workforce. Arch Dermatol. 2001;137(10):1303-1307.doi:10.1001/archderm.137.10.1303

http://www.ncbi.nlm.nih.gov/pubmed/11594853

24.

McCleskey

PE.

Gilson

RT.

DeVillez

. Medical student core curriculum in dermatology survey. J Am Acad Dermatol. 2009;61(1):30-35.doi:10.1016/j.jaad.2008.10.066

http://www.ncbi.nlm.nih.gov/pubmed/19410336

25.

Kirshen

Shoimer

Wismer

DesGroseilliers

J-P.

Lui

. Teaching dermatology to Canadian undergraduate medical students. J Cutan Med Surg. 2011;15(3):150-154.doi:10.2310/7750.2011.10021

http://www.ncbi.nlm.nih.gov/pubmed/21561583

26.

Ulman

CA.

Binder

SB.

Borges

. Assessment of medical students' proficiency in dermatology: are medical students adequately prepared to diagnose and treat common dermatologic conditions in the United States? J Educ Eval Health Prof. 2015;12:18 doi:10.3352/jeehp.2015.12.18

http://www.ncbi.nlm.nih.gov/pubmed/25989840

27.

Hansra

NK.

O'Sullivan

Chen

CL.

Berger

. Medical school dermatology curriculum: are we adequately preparing primary care physicians? J Am Acad Dermatol. 2009;61(1):23-29.doi:10.1016/j.jaad.2008.11.912

http://www.ncbi.nlm.nih.gov/pubmed/19409656

28.

Hanif

MM.

Akram

Mustafa

et al. Medical school dermatology curriculum - are our graduates adequately prepared and aligned to community needs? JSZMC. 2017;8(2):1147-1152.

29.

Pariser

RJ.

Pariser

. Primary care physicians’ errors in handling cutaneous disorders. J Am Acad Dermatol. 1987;17(2):239-245.doi:10.1016/S0190-9622(87)70198-4

30.

University of Ottawa Undergraduate Medical Education – Clerkship . URL. Jan 29, 2019. http://med.uottawa.ca/undergraduate/education/electives/clerkship

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.09 MB

0.00 MB

The Impact of Suspension of Dermatology On-Call Services

Abstract

Background

Objectives

Methods

Results

Conclusion

Keywords

Get full access to this article

References

Supplementary Material