Urgent care referrals demonstrate need for "real-time" dermatology e-consultation

Introduction: Dermatologists’ ability to serve the entirety of their regional patient population is limited by long appointment wait times and a limited workforce. This disproportionately affects urgent dermatological conditions and severely impacts diagnosis, treatment, and patient outcomes. Our study aims to determine whether a “real-time” dermatology e-consultation would improve care provided by Urgent Care clinics (UC) and minimize unnecessary urgent referrals to University of Rochester Dermatology (UR-Derm). Methods: This retrospective study examined 807 urgent referrals from 11 UC sites to UR-Derm between January 2021 and August 2022 for percentage of completed referrals, average appointment wait time, and concordance between UC and UR-Derm diagnoses. Five board-certified dermatologists completed a REDCap survey to determine if 40 UC referral cases could be adequately managed by UC providers with e-consultation. Results: Most UC referral patients were white (73.9%) females (53.9%) with a mean age of 37.9 ± 20.8 years. Of the 807 referrals, 41.4% were seen by UR-Derm, whereas 58.6% were not seen. Of the referrals seen, 55.9% of UC diagnoses did not match UR-Derm diagnoses. Average wait time to be seen by UR-Derm was 38.2 days (median = 15 days). Dermatologists reported that 83.5% of cases could be handled either by an e-consult or an e-consult with a dermatology follow-up (X2(1, N=187) =115.6, p<0.0001). Conclusions: The predominant number of urgent UC referrals not being seen indicates a severe gap in access to dermatology. Additionally, a high incorrect match rate between UC and UR-Derm diagnoses further hinders patient outcomes. These issues could be ameliorated, as suggested by our surveyed dermatologists, by an effective, “real-time”, dermatology e-consult service to provide patients with access to urgent dermatological care.