Abstract
Background: The Photo Triage concept was first introduced in Causeway Hospital in May 2012, specifically for suspect cancer red flag referrals from primary to secondary care. It facilitated the capture of dermatology images in Secondary Care by a medical photographer. Images were presented, along with referral information, to the dermatology consultant for triage. Analysis of the triage outcome indicated 80% of the cases did not require a secondary care outpatient appointment.
The Photo Triage concept was further developed to facilitate the capture of images in primary care in 2018. Images could be attached to the CCG referral to enable both the images and clinical information to be reviewed by the Consultant Dermatologist at point of Triage.
Both pilots, concluded that when a treating consultant had an image, up to 30% of referrals did not require an Outpatient clinic, and up to 50% of those referrals could be downgraded.
Drivers for Change:There are in excess of 50,000 dermatology referrals annually across Northern Ireland. Approximately half of referrals are for the diagnosis and management of suspected skin cancer. The current HSC Trust delivered Dermatology Service face challenges from demand pressures, recruitment, retention, an increasing part-time workforce, skill mix challenges and the delivery of core commissioned capacity.
The pathway would provide an e-Referral solution which can easily & securely capture and transfer images, of the right quality, and facilitate dermatology photo triage clinical decision-making, with images.
Strategic Direction: This project was aligned to several key strategic documents including;
- Health and Wellbeing 2026 – Delivering Together
- Elective Care Framework June 2021 –
- eHealth and Care Strategy for Northern Ireland
Regional Implementation Project
A formal project team was established within to oversee the system procurement, integration, deployment, training and contract management.
Essential work was undertaken by the Project Team in advance of the project Go Live including procurement of specialist equipment, development of SmartDerm App, development and alignment of CCG/ NIECR and other systems and development of a regional NI wide Local Enhanced Service.
The project was launched in December 2021 via a phased implementation and full regional roll out to all GP Practices and Trusts across NI was completed by July 2022.
Further Developments: The Dermatology Photo Triage Pathway has been expanded to the Skin Cancer Detection Service on the Action Cancer Big Bus model as of January 2023. Patients are assessed by Clinical Nurse Specialists and if required, will be referred to Secondary Care using the Pathway.
The Pathway has been further expanded to referrals for suspected basal cell carcinoma requiring urgent assessment with specialists in secondary care and included the development of revised referral guidance for this cohort of patients.
Impact/Outcomes: There has been a total of 9608 referrals via the Dermatology Photo Triage pathway. (September 2023). Of these, 13% (1249) have been referred back to GP with advice requiring no outpatient appointment in secondary care.
Next Steps: Work has also commenced on the development of a Regional Photo e-Triage process and Regional e-Triage Competency Framework.