The Role of Inpatient Dermatology Consultations

Alex Sherban, BM Matthew Keller, MD

Cutis. 2021;108(4):193-196.

Abstract

Inpatient dermatology has been shown to have profound effects on the care of hospitalized patients. However, dermatology consultations remain an underutilized resource. The purpose of this study was to demonstrate how dermatology affects the hospitalization of inpatients while highlighting the breadth of services provided. This cross-sectional retrospective study included all inpatient dermatology consultations completed at a large tertiary-care facility in an urban setting. It aimed to investigate the reasons for consultation, as well as the effects on diagnosis, management, disposition, and cutaneous condition by time of discharge. This study provides evidence supporting the integration of the dermatologist into the care of hospitalized patients by illuminating lesser-known areas of impact.

Introduction

Dermatology is an often-underutilized resource in the hospital setting. As the health care landscape has evolved, so has the role of the inpatient dermatologist.^[1,2,3] Structural changes in the health system and advances in therapies have shifted dermatology from an admitting service to an almost exclusively outpatient practice. Improved treatment modalities led to decreases in the number of patients requiring admission for chronic dermatoses, and outpatient clinics began offering therapies once limited to hospitals.^[1,4] Inpatient dermatology consultations emerged and continue to have profound effects on hospitalized patients regardless of their reason for admission.^{[1,2,3,4,5,6,7,8,9,10,11]}

Inpatient dermatologists supply knowledge in areas primary medical teams lack, and there is evidence that dermatology consultations improve the quality of care while decreasing cost.^[2,5,6,7] Establishing correct diagnoses, preventing exposure to unnecessary medications, and reducing hospitalization duration and readmission rates are a few ways dermatology consultations positively impact hospitalized patients.^{[2,5,6,7,9,10]} This study highlights the role of the dermatologist in the care of hospitalized patients at a large academic medical center in an urban setting and reveals how consultation supports the efficiency and efficacy of other services.

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Table 1 Patient Characteristics, Reasons for Consultation, and Primary Teams Requesting Dermatology Consultations
Demographics	Patient data
No. of patients	253
Sex, n (%)
Male	118 (47)
Female	135 (53)
Mean age, y	55
Race, n (%)
White	143 (57)
Black	86 (34)
Asian	13 (5)
Hispanic or Latino	10 (4)
Not reported	1 (0.4)
Reason for consultation, n (%)
Assist in diagnosis	195 (77)
Assist in management	56 (22)
Full-body skin examination	13 (5)
Primary consulting team, n (%)
Internal medicine	86 (34)
Emergency medicine	36 (14)
Hematology/oncology	27 (11)
Cardiology	26 (10)
Critical care	16 (6)
Neurology	15 (6)
General surgery	14 (6)
Gastroenterology	7 (3)
Obstetrics/gynecology	6 (2)
Neurosurgery	6 (2)
PM&R	4 (2)
Family medicine	2 (<1)
Vascular surgery	2 (<1)
Cardiothoracic surgery	2 (<1)
Psychiatry	2 (<1)
Transplant surgery	1 (<1)
Otolaryngology	1 (<1)

Abbreviation: PM&R, physical medicine and rehabilitation.

Table 2 Most Common Final Diagnosis Categories Following Dermatology Consultation and the Effects on Care (N=253)
	Patient data
Total no. of consultations	253
Most common diagnoses, n (%)
Inflammatory and autoimmune	99 (39)
Infectious	58 (23)
Drug reactions	51 (20)
Other	38 (15)
Vascular	21 (8)
Neoplastic	18 (7)
Effects of consultation,^a n (%)
Diagnoses changed	142 (56)
Management changed	218 (86)
Required biopsy	71 (28)
Discharged following consultation	34 (13)
Improved by discharge	129 (51)

^a The effects of the consultation include all consultations regardless of reason. Single consultations may have resulted in more than 1 final diagnosis.

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