BT16: Disaster-recovery modelling to shape services: a dermatology helpline as a telemedicine intervention during the initial surge of the COVID-19 pandemic

D. Middleton, V. Campbell and S. Hoey

Royal Victoria Hospital, Belfast, UK

The COVID-19 pandemic brought challenges in dermatology care. This was due to service relocation, staff redeployment and advice on social distancing, restricting hospital footfall. A medic-led dermatology helpline was developed for the initial surge stage of the pandemic. The aim of the service was to maintain key services, while reducing departmental footfall. Analysis was performed on the service provision and support themes provided by this intervention during the initial surge phase of the COVID-19 pandemic. The service was staffed and coordinated by two specialist trainee registrars in dermatology. All enquires were responded to within 4 h. The service received 225 calls during the first 30 days of the first surge phase of the pandemic in the local region. A reduction in footfall was maintained with this service – with only 2·2% of all enquires requiring a face-to-face, rapid-access appointment. This was achieved by using photo triage assessment and strengthening communication in the interface between primary and secondary care. Theme analysis was performed on calls received. The most common theme was for treatment advice directly from patients, which accounted for 33% of calls. Issues related to flares of pre-existing skin conditions. A third of these calls for treatment advice required a modification of therapy. Where required, medications were either posted from the hospital pharmacy directly to patient homes, or via their general practitioner to a nominated local pharmacy, to avoid departmental attendance. An additional role was that of treatment access for patients to acquire hospital-only dispensed medications, including ‘red label’ drugs. The service facilitated telephone review, and subsequent dispensing from the hospital pharmacy couriered directly to patients’ homes. The helpline also served as a support for patients receiving biological therapies. Calls from patients on biological therapy accounted for 18% of calls – advice related to shielding advice or for letters of support for employers. Helpline services are not a new concept in healthcare with published literature in other specialties. However, a PubMed review revealed no publications regarding helplines in dermatology – a specialty centred on visual assessment. Reflection on our approach to change revealed key differences vs. traditional quality-improvement methodology, with our approach akin to a disaster-recovery template used in disaster planning. This service, a product of necessity, shows how a telemedicine intervention in the form of a medic-led helpline, can be used to maintain key services in a challenging environment.