Virtual Teledermatopathology Clinicopathologic Correlation Rounds For Inpatient Skin Biopsies: A Quality Improvement Project

Three-quarters of dermatology programs have dermatopathology (DP) rotations, but these largely occur in the final year of residency. Standard teaching with microscopes and glass slides is limited by available space, inconvenient locations, and new need for social distancing during the COVID-19 pandemic. These barriers are particularly salient for inpatient consultative dermatology services, which biopsy a broad range of pathologies and provide value in rapid clinicopathologic correlation. Several studies have assessed modifying curricula with digital platforms and online databases of virtual slides, but the use of live interactive teledermatopathology (TDP) to actively review skin biopsies performed by the dermatology inpatient consult service has not been systematically evaluated. In this study, a retrospective chart review of a representative baseline 3-month period found that only 2 out of 36 (6%) biopsy slides were personally reviewed by the consultative dermatology team. Our intervention uses live-interactive video slide TDP rounds to review skin biopsies performed by the inpatient dermatology consult service, sampled during a 3-month study period. The primary outcome is proportion of slides reviewed by the inpatient consultative team compared with the historical control period. We use slide capture software in combination with a secure HIPAA compliant platform that integrates chat, video conferencing, and clinical images. One and a half months into the intervention, 25/27 (92.6%) biopsies have been reviewed by the inpatient consult team. Conference discussion and clinicopathologic correlation has likely led to a change in clinical and pathologic interpretation in at least three cases.