Journal Article

The Dermatology Fast Track as a Model for Integrated Care Pathways Between Emergency Medicine and Outpatient Specialty Services

Gavelli, Francesco, Savoia, Paola, Bellan, Mattia, Cammarata, Edoardo, Zavattaro, Elisa, Airoldi, Chiara, Fazzini, Ugo, On Behalf Of The Dft Group

2025

Overview

Dermatological conditions account for a significant proportion of Emergency Department (ED) visits but are often misclassified at triage and managed without timely specialist input. A Dermatology Fast Track (DFT) pathway was implemented to improve diagnostic accuracy, optimize resource use, and enhance integration between ED and dermatology services. We conducted a retrospective study of patients referred through the DFT between April 2023 and October 2024. Demographics, triage codes, diagnoses, comorbidities, prior healthcare utilization, treatments, and follow-up were analyzed. Concordance between ED and dermatology-assigned triage codes was assessed using Cohen's kappa, and temporal trends in referrals were explored. Of 621 patients referred, 554 were included (mean age of 47.7 years and balanced sex distribution). Most were triaged green (75.6%) or white (23.1%), and 99.5% were discharged home. Infectious dermatoses (21.1%) and eczema (17.7%) were most frequent, with age-specific variations. Combined topical and systemic therapy was prescribed in 66.1% of cases, and 30.9% were referred for follow-up. Concordance between ED and dermatology triage codes was limited (58.7% agreement; Cohen's kappa 0.25), with frequent down-grading of priority by dermatologists. Seasonal peaks were observed, with higher demand during summer months. The DFT pathway streamlines ED care, ensuring timely management of acute dermatological conditions and reducing overcrowding. Seasonal demand fluctuations and discrepancies in triage highlight the need for targeted staff training, structured follow-up, and resource planning. Overall, the DFT is an effective model for enhancing ED efficiency, diagnostic accuracy, and patient care; however, as outcomes were assessed only in the DFT cohort and the study was conducted in a single center using Italy's color-coded triage system, the generalizability of these findings may be limited. Multicenter studies are needed to confirm its broader applicability.

• Publisher: MDPI AG
• Subject: Adult / Aged / Ambulatory Care - methods / Codes / Delivery of Health Care, Integrated / dermatological emergencies / Dermatology / Dermatology - methods / efficiency in healthcare / Emergency medical care / Emergency medicine / Emergency Medicine - methods / Emergency service / Emergency Service, Hospital - organization & administration / Emergency Service, Hospital - statistics & numerical data / Female / Health services utilization / healthcare integration / Hospitals / Humans / Male / Medical research / Medicine, Experimental / Middle Aged / Patient admissions / patient flow management / Patient satisfaction / Retrospective Studies / Skin diseases / Skin Diseases - diagnosis / Skin Diseases - therapy / Software / Triage - methods / Tumors / Urticaria / Variables