Recommendations not followed after dermatology consultations

Adherence by other staff to recommendations from in-hospital dermatology consultations is less than impressive, suggesting a need to improve communication between teams or introduce dermatology education or upskilling programs.

A retrospective review of all 306 dermatology consultations for hospital inpatients at Westmead Hospital from June 2018 through to November 2019 found subsequent adherence to recommendations was 61% overall.

This represented missed opportunities to improve patient outcomes and quality of life, the study authors said.

Adherence to investigation recommendations was 61.3% – including administrative tasks (67.8%) such as ordering tests and procedural follow-up (43%) such as collecting skin scrapings or other samples not including skin biopsies.

Adherence to management recommendations such as topical and systemic medications or other skin care measures was 65%.

The study, published in the Australasian Journal of Dermatology, found non-adherence was highest for ‘other’ management such as leg compression, leg elevation, soap-free washes (43%).

“Topical treatment recommendations had no documented changes in 22% of cases, whereas systemic treatment recommendations had no documented changes in 17% of cases.”

The study said the rates of adherence were on the lower end of the range compared to the literature (67.4%-93%).

The investigators said the referring teams may be under too much time pressure to complete the recommendations, may not consider them necessary, or may expect the dermatology department to complete them as part of the consultation.

Alternatively, some junior doctors who are delegated the responsibility may not have the necessary skills or expertise to perform suggested procedural tasks.

“If teams are under too much pressure and the hospital system, with its limited resources, cannot improve this situation, the dermatology team could possibly complete such procedures,” the study said.

“If this is expected as part of the dermatology consultation, then this could be identified and a solution implemented.”

“If junior staff do not feel they have the skills or expertise, workshops could be organised by the dermatology department aimed at these staff members to improve their abilities in a non-judgemental environment.”

In addition, communication issues within and between teams may be a contributory factor as in most cases, recommendations were only described in the medical record with no direct discussion between teams.

The investigators said survey-based evaluation of the beliefs of hospital clinicians would be helpful in identifying the reasons underlying non-adherence and correcting the issues.

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