Association of Dermatology Consultations With Patient Care Outcomes in Hospitalized Patients With Inflammatory Skin Diseases

Abstract

IMPORTANCEThe value of inpatient dermatology consultations has traditionally been demonstrated with frequency in changes of diagnosis and management; however, the impact of dermatology consultations on metrics such as hospital length of stay and readmission rates remains unknown. OBJECTIVE To determine the association of dermatology consultations with patient care in hospitalized patients using objective values. DESIGN, SETTING, AND PARTICIPANTSWe retrospectively queried the deidentified database of patients hospitalized between January 1, 2012, and December 31, 2014, at a single university medical center. A total of 413 patients with a primary inflammatory skin condition discharge diagnosis and 647 patients with primary inflammatory skin condition admission diagnosis were selected.MAIN OUTCOMES AND MEASURES Hospital length of stay and 1-year readmission with inflammatory skin conditions. RESULTS The 413 patients with a primary inflammatory skin condition discharge diagnosis were 61.0% female and had a mean (SD) age of 55.1 (16.4) years. The 647 patients with primary inflammatory skin condition admission diagnosis were 50.8% female and had a mean (SD) age of 57.8 (15.9) years. Multivariable modeling showed that dermatology consultations were associated with a reduction of 1-year inflammatory skin condition readmissions among patients who were discharged primarily with an inflammatory skin condition (readmission probability, 0.0025; 95% CI, 0.00020-0.030 with dermatology consult vs 0.026; 95% CI, 0.0065-0.10 without; odds ratio, 0.093; 95% CI, 0.010-0.840; P = .03). No other confounding variable was associated with reduction in readmissions. Multivariable modeling also showed that dermatology consultations were associated with a reduction in the adjusted hospital length of stay by 2.64 days (95% CI, 1.75-3.53 days; P < .001).CONCLUSIONS AND RELEVANCE Dermatology consultations were associated with improvements of outcomes among hospitalized patients. The expansion of the role of dermatology consultation services may improve patient care in a cost-effective manner.

Readmission Risk Factors and Complications in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

“…While some of these factors are admittedly difficult to change in an inpatient setting, one aspect that can be arranged is peridischarge follow up. Highly specific to SJS/TEN, inpatient dermatology consultation and subsequent dermatology follow up has been shown to lower odds of readmission by up to 10-fold [9]. In the setting of critical diseases such as SJS/TEN, awareness of the barriers for underinsured and low-income patients, as well as elderly patients, are essential to a successful post-hospitalization course.…”

Inpatient dermatology: a paradigm shift in the management of skin disease in the hospital

“…Length of stay was reduced with inpatient consultation for dermatological disease by 2.64 days in one study and 2.1 days in another study . The same study by Milan‐Nejad et al . also found a decrease in hospital readmission rates in this cohort of patients.…”

“…Multiple studies show the admitting hospital service misdiagnoses skin disease at rates of between 45% and 78% of the time . Length of stay was reduced with inpatient consultation for dermatological disease by 2.64 days in one study and 2.1 days in another study . The same study by Milan‐Nejad et al .…”

Diagnoses of hospitalized patients with skin abnormalities prompting biopsy by consulting dermatologists: A 3‐year review from a tertiary care center

“…These studies typically confirm that biopsy is an important adjunctive test used by dermatology hospital services, and have been reportedly performed in approximately 18% to 40% of all consultations . When cohorts of hospital consultations related to patients with specific dermatologic disorders or underlying systemic diseases are reviewed, biopsies have been reported in approximately 5% to 48% . However, we were unable to identify a single study that explored the diagnoses of patients who specifically underwent a biopsy procedure.…”