BT05 Developing a novel patient communication app to optimize the teledermatology fast-track skin cancer ‘direct-to-surgery’ pathway

Abstract The use of teledermatology in dealing with the ever-increasing numbers of urgent suspected skin cancers referrals in the UK is now considered standard of care. Clinicians routinely make management decisions based on submitted clinical and dermoscopic images from primary care, without seeing patients face to face. Many such patients are listed for ‘direct to surgery’ in an attempt to shorten the patient pathway and save a potentially unnecessary hospital appointment. However, concerns of listing patients directly for surgery without a consultation have been raised, in particular relating to patients’ preparedness for the procedure and their ability to give appropriate informed consent. We have previously addressed this concern by ensuring all patients received a standardized preprocedure telephone call akin to a remote consultation. While the benefits of this approach prevented an unnecessary hospital visit for the patient, it still required direct clinical activity in secondary care. Our institution has thus developed a teledermatology direct-to-surgery patient communication app, to provide all patients with urgent suspected skin cancer with the necessary information prior to their surgical procedure. The app also enables patients to interact directly with their health record in secondary care, allowing enrolled patients to provide all the necessary medical information required prior to their procedure. Furthermore, within the app, patients are provided with bespoke information relating to their surgical procedure, be that a diagnostic punch biopsy, curettage or a formal excision. An embedded patient-centred video in the app details material risks associated with each specific procedure, as well as addressing the commonest queries that were raised during our traditional preprocedure telephone call. Since the launch of the app in our institution, patient satisfaction with the direct-to-surgery pathway has been very high, with the overwhelming majority of patients rating their experience as excellent. Importantly, in secondary care, the use of the app has resulted in a 10-fold efficiency saving in clinical time as the preprocedure phone call is no longer routinely required. We have also noted that fewer surgical procedures have been postponed or cancelled on the day, thus highlighting the utility of the teledermatology patient app in reducing waste and increasing productivity. Our presentation discusses the development and implementation of the teledermatology direct-to-surgery pathway app and highlights its potential benefits for both patients and clinicians alike. We will also address health inequality issues relating to any patient unable or unwilling to engage with the app and the governance issues we have implemented to ensure patient safety throughout the teledermatology direct-to-surgery pathway.