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Red flag referral management in a U.K. dermatology department during the COVID-19 pandemic: Bucking the trend with a disaster-recovery approach
British Journal of Dermatology ; 183(SUPPL 1):211-212, 2020.
Article in English | EMBASE | ID: covidwho-1093696
ABSTRACT
The COVID-19 pandemic heralded a new era of working within the National Health Service, and almost overnight deconstructed long-established routines. One of the most alarming trends to emerge is a reduction in cancer diagnoses vs. the period prior to the outbreak. In some countries, this effect has been most pronounced for skin cancers. With the onset of social distancing, the need to reduce hospital footfall and > 50% staff redeployment, our skin cancer service and red flag (RF) pathway was forced to redefine. Working from newly established guidelines, patients with skin cancer were risk stratified, taking into account any comorbidities that may increase susceptibility to COVID-19. Mohs surgery and the regional melanoma sentinel lymph node biopsy service were suspended. Treatment delays were reported to and centralized within the newly adapted telelink multidisciplinary meeting (MDM). Given such exceptional service disruption, we sought to evaluate the RF 'journey' during the pandemic. We retrospectively analysed RF referrals into our department from 25 March to 14 June 2020, comparing these with the same 3-month period in 2019. During lockdown there were 349 RF referrals from primary care, compared with 667 RF referrals in the corresponding 2019 period, with a 29% increase in MDM cases. In 2019, we diagnosed 14 squamous cell carcinomas (SCCs) and six melanomas, with a mean time from referral to outpatient assessment of 38 days, and 88 days to definitive surgical treatment. During lockdown we had capacity for 54 RF cases to be assessed face-to-face weekly. Thirteen SCCs and four melanomas were diagnosed, with the majority seen within 2 weeks. Pending histology for lesions clinically suggestive of SCC and melanoma, these figures may increase to 17 and seven, respectively. The higher pick-up rate during lockdown was despite only 21% of confirmed RF cases having been assessed by the referring general practitioner in person. The COVID-19 pandemic compelled our RF service to streamline, allowing for rapid access to standalone RF clinics with increased see-and-treat capacity. These strategic adjustments in a continually fluid working environment parallel a disaster-recovery model of service delivery. In contrast to the more familiar quality improvement approach, disaster-recovery methodology allows for interventions and concepts for change to be identified at the outset, with ad hoc data gathering. Despite the obvious challenges, it is reassuring that our skin cancer service maintained essential and urgent cancer treatment. The success of this crisis-management approach serves as a reminder that even during adversity there can be opportunities for learning and service development.

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: British Journal of Dermatology Year: 2020 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: British Journal of Dermatology Year: 2020 Document Type: Article