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Innovation in Referral Management:
Innovation in Referral
Photo--triage for Skin Cancer Referrals
triage for Skin Cancer Referrals
C Morton, on behalf of the Photo-Triage Steering Group, NHS Forth Valley
Background
Demand for specialist dermatology services continues to increase
Following photo-triage, a visit to the conventional consultant clinic was
annually,
annually w
er 100,000 new
patient referrals
out patient
saved in 72% of referrals, with more directly attending for definitive care:
consultation in Scotland during 2008.
~40% of referrals concern suspected skin malignancy, challenging us to
Normal Referral Pathway Versus Phototriage
provide a safe timely service to reassure patients with benign growths
whilst efficiently progressing the care of those with skin cancer.
Limited resources as well as the continued drive towards improved
national cancer and general out-patient access times is placing severe
Phototriage
strain on specialist departments.
It remains difficult to triage referrals via letter alone and, having
Referrals (%) 60
assessed different models of triage, we developed a community-based
system of high quality image capture.

What is photo-triage?
Clinic Options
Photo-triage is the use of a digital image of skin lesions to help the
speciali
list team at the time
o vetting GP referrals. The image is used t
help direct patients to the most appropriate clinic as quickly as possible.
The mean waiting time to definitive treatment for patients with
Superficial Spreading Melanoma identified via Photo-triage
melanoma, squamous cell and basal cell carcinomas were all reduced
allowing for fast-track surgery
using photo-triage: 36, 28, and 35 days respectively, compared with 39,
50, and 58 days for conventional referrals

To use opportunities created by photo-triage for a ‘First Stop, Correct Stop’
experience for patients referred with a suspected skin cancer.

Benefits
We report an observational study of conventional vs. photo-triage journeys
‘First-stop, correct stop’ achieved in 93% of patients, saving on
between Jan-Jun 2008. Data from 188 conventional (where all patients
unnecessary additional hospital visits
were booked onto a consultant clinic on the basis of referral letter only)
Initial consultant visit avoided in 72% referrals, freeing-up
and 289 photo-triage referrals was available for study.
appointments for other patients to attend the service more rapidly.
Rapid assessment for skin cancer patients: triage permits patients with
suspicious lesions to be fast-tracked for surgery or clinic assessment.
Community photo-triage has permitted improved referral management
p ients with suspect
ed skin cancer
And the final word to a patient comment:
Conventional Patient Journey
Patient Journey Phototriage
Consultant
Reassure
Patients
Nurse led
Nurse led therapy
Consultant
photographed
What's next?
at Community
Complete cost effectiveness analysis of standard vs. triage referral methods
Referral to other specialist
Determine best method for extending community photography
Patient photographs
Referral to other
triaged by consultant
Assess potential for direct reassurance via phone/e-mail/letter to patients
specialists
with obvious benign lesions
All patients seen by consultant
Steering Group: Sandra Auld, Scottish Centre for Telehealth; From NHS Forth Valley: Paul Baughan, Lead CancerGP; Karen Bonnar, Cancer Services; Fiona Downie, Project Manager; John Hunter, Medical Photographer; Colin Morton, Consultant Dermatologist;
Mary Orzel, Cancer Services manager; Dave Simpson, e-health; Brenda Smith, Dermatology Nurse Specialist; John Wells. e-health
For more information: colin.morton@nhs.net

Source: http://www.wonkydonkey.tk/pdf/dermatology.pdf

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