Case study summary:
Dermatology services in Leicester, Leicestershire, and Rutland integrated care system (ICS) are embracing digital innovation so that patients with suspected skin cancer can be seen more quickly. This comes after a pilot using artificial intelligence (AI) led to increased capacity within multiple teams to meet the rise in referrals following the COVID-19 pandemic.
Leicester, Leicestershire, and Rutland integrated care system (ICS)
What was the aim:
The University Hospitals of Leicester (UHL) Dermatology Service treats over nine thousand patients a year on their 2 week wait skin cancer pathway.
Wanting to reduce the pressures that the team and overall system was facing, the aim was to offer an innovative solution to sustainably increase capacity, perform better on targets and provide faster diagnosis for people with suspected skin cancer in the community.
What was the solution:
In March 2022, partnership working began evolving within Leicester, Leicestershire and Rutland ICS as they were affected by a national shortage of dermatologists. Multiple partners within the system such as the Dermatology Service, LLR Elective Care team, UHL Cancer Centre and Alliance teams created a cross-team collaborative working environment which began to prioritise sharing insights between teams.
Realising the potential benefits and improved patient outcomes from this closer way of working, a partnership was developed with Skin Analytics, an AI powered tele-dermatology provider, so that everyone in the system could work together to improve their national skin cancer performance targets.
The technology allows a healthcare professional to take photographs of each skin lesion using a smartphone with a special magnifying lens attached. These photographs are then encrypted and analysed by the AI DERM technology and can also be reviewed by dermatologists if further investigation is needed.
Patients get their results by letter in two to three weeks, or more quickly by phone if they need a face-to-face consultation.
This new technology as also used to train dermatology registrars to recognise lesions. This shared experience brought innovation and contributed towards developing a collaborative working environment.
What were the challenges:
The UHL dermatology service was under considerable pressure because of a shortage of dermatology consultants and the COVID-19 pandemic, which led to a higher number of more complex referrals.
Also, the complexity of lesions being presented which resulted in cancer had increased from around 7% to around 15%. This placed even higher pressure on the service to meet the national 2 week wait skin cancer target.
What were the results:
Over a third of patients referred during the first six months of the service were discharged without needing to attend a hospital appointment (799 out of 2023 patients, or 37%). This has helped free up appointments for other patients and reduced pressure on the system.
The new service was launched at Loughborough Community Hospital in March and a further three sites are now up and running – in Hinckley, Melton and Leicester city.
The team are now trying to secure ongoing investment in the service.
What were the learning points:
Teams are now using this new technology to train dermatology registrars to recognise lesions. Bringing this service into the community and creating with a culture of sharing knowledge has built the foundation for the system to ensure that skin cancer appointments are taken by those who need them most – demonstrating the value of partnership working.