P160 A retrospective evaluation of the communicative processes of a teledermatology service in the UK

Abstract National Health Service England has prioritized increasing investment and promoting the uptake of Advice and Guidance (A&G) as a key strategy to reform elective care and reduce waiting lists by 2029 [NHS England. Reforming elective care for patients. Available at: https://www.england.nhs.uk/wp-content/uploads/2023/04/reforming-elective-care-for-patients.pdf (last accessed 20 February 2025)]. However, the success of this pathway relies on effective communication between clinicians. This project aimed to evaluate the quality of communication between referring and advising clinicians, assessing adherence to the British Association of Dermatologists (BAD) teledermatology quality standards. The findings will guide improvements in clinician communication, enhance care quality and improve the efficiency of the A&G pathway. A retrospective analysis of A&G referrals (between January 2024 to March 2024) assessed referral quality against BAD standards, evaluating 10 history components for inflammatory dermatosis and lesion referrals (including onset, location and symptoms). Referred images were evaluated against five image quality criteria: for inflammatory dermatosis, this included resolution, flash photography from two angles, neutral backgrounds, wide image and macroscopic views. For lesions, this included the presence of an anatomical marker and dermoscopic image. Specialist responses were evaluated for the inclusion of a diagnosis, management, outcome clarity, review timeframes and educational materials. Of the 1938 referrals analysed (936 lesions, 1002 inflammatory dermatoses), 4% and 3%, respectively, included all 10 history components. A satisfactory history (defined as ≥ 70% of components) was met by 40% of inflammatory dermatosis and 23% of lesion referrals. Of referrals with images (60%), 35% met satisfactory quality standards (≥ 80% adherence to five-point criteria). In total, 64% of inflammatory dermatosis and 46% of lesion referrals had high-quality responses. Around one-half (47%) of all referrals resulted in secondary care appointments; of these, 61% were inflammatory dermatosis and 39% were skin lesion referrals. Overall, 59% of responses for inflammatory dermatosis included educational materials for referrers and patients. Conversely, 3% of lesion referrals had this. Decreasing referral quality was associated with a decline in response quality. Higher referral quality correlated with more patients managed in the community. Our study highlights significant communication deficiencies in A&G referrals, underscoring the need for targeted interventions to enhance both referral and response quality. Planned actions include integrating A&G prompts, providing local clinician training, disseminating visual aids for improving referral and response quality, and developing patient resources for better image quality. Standardized protocols and tailored response repositories will be created for specialists. Annual audits will ensure sustained improvements. These measures aim to enhance communication, streamline the A&G pathway, reduce waiting lists and ensure patients receive care in the most appropriate setting.