P169 Evaluation of a phototriage service: effective referral management tool or sunk cost fallacy?

Abstract The phototriage service in Northern Ireland, fully implemented in June 2022, enables rapid triage of lesions concerning for skin cancer sent directly from general practitioners to secondary care. Potential outcomes are ‘discharge with advice’, outpatient face-to-face assessment, referral for surgical removal or referral to another specialty. Quality standards require four high-quality images (macroscopic and dermoscopic) with ruler measurement, together with body image map and patient identifiers. A service evaluation audit was conducted to assess referral numbers, image quality, triage outcomes and changes compared with a baseline audit (June 2022 to April 2023). Data from primary care phototriage referrals within a single trust from June to July 2024 were analysed. Data captured included lesion characteristics, image quality, triage outcomes and final diagnosis. In total 239 referrals were analysed, compared with 250 in the previous 10-month audit. Outcomes were as follows: 66% still required outpatient assessment, 14% were discharged, 12% were downgraded to urgent, and 8% were triaged direct to surgery, compared with 70%, 10%, 2% and 16%, respectively, in the previous audit. While 83% of referrals included the required four images, only 39% met the overall image quality standard. Conversion rates revealed 9% were true red flag lesions, and 21% were true urgent lesions. The audit showed an 848% increase in monthly referrals, with 239 cases in 1 month compared with 250 over 10 months previously. Most phototriage referrals still required face-to-face appointments, with lower discharge rates and fewer cases directed to surgery compared with the baseline data. Poor image quality and failure to meet baseline standards likely contribute to the high outpatient appointment rates. Inappropriate referrals, including lesions in hair-bearing sites and multiple lesions, accounted for 11% of cases, and also generate further outpatient appointments. Current service structure funding with allocation of consultant programmed activities to phototriage sessions in place of a face-to-face clinic raises questions about resource efficiency. Better education and photography facilities are essential to improve referral quality. However, the marked increase in referrals since the service’s implementation suggests the system’s accessibility may be potentiating demand. Strategic investments in time, resources and workforce are critical in addressing the growing challenges and ensuring the service’s sustainability and effectiveness.