DS01 ‘An app a day keeps the consultations at bay!’ Introducing a novel patient communication app to optimize the fast-track skin cancer ‘direct-to-surgery’ pathway

Abstract Fast-track skin cancer referrals to secondary care continue to rise on an annual basis in the UK. In an attempt to deal with the increasing rates of referrals, many dermatology departments now make management decisions based on submitted clinical and dermoscopic images from primary care, without seeing the patient face to face. This includes listing patients ‘direct to surgery’ in an attempt to shorten the patient pathway in order to meet the national 28-day faster diagnostic standard. This standard requires that patients be told whether they do or do not have cancer within 4 weeks of their original referral. However, a major concern of listing patients directly for surgery without a consultation relates to their preparedness for the procedure and their ability to give appropriate informed consent. In our institution, we have previously addressed this concern by ensuring all patients received a standardized preprocedure telephone consultation. While the benefits of this approach include preventing an unnecessary hospital visit for the patient, it still requires direct clinical activity in secondary care. Our institution has thus developed a direct-to-surgery patient communication app, to provide patients with suspected skin cancer all the necessary information prior to their surgical procedure. The app also enables patients to interact directly with their health record in secondary care, importantly allowing them to provide all the necessary medical information required by us 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 within the app details material risks associated with their procedure (addressing potential concerns raised by the landmark Montgomery ruling in 2016), as well as addressing queries that were frequently raised during our traditional preprocedure telephone consultations. 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 consultation is no longer routinely required. Our presentation will discuss the development and implementation of the direct-to-surgery pathway app and highlight its potential benefits for both patients and clinicians. We shall also address concerns relating to patients who are unable to interact with the app, including how strict governance processes ensure no patient ‘slips through the system’.