Increasing pressure on inpatient beds has no doubt contributed to the ongoing reduction in designated dermatology beds within acute hospital trusts. Studies in Scotland1 and Manchester2 have highlighted an 82% and 57% reduction respectively in dedicated dermatology beds in recent years. This loss of acute beds for the treatment of patients with severe skin disease has led to a shift away from patient admission towards management in the community with expensive immunosuppressant therapies associated with potentially serious side effects.
We report a study from a designated 12-bedded dermatology ward at Amersham General Hospital in Buckinghamshire, which investigated the impact of admission on the Dermatology Life Quality Index (DLQI)3 of patients with skin disease.
In total, 107 patients were admitted to the ward over a six-month period. Fifty-four per cent (58/107) were female and 46% (49/107) male. The average age was 53.8 years (range 16–94 years). The mean length of stay was 13.9 days (range 2–57 days). Fifty-two per cent of admissions to the ward were planned (eg photoinvestigations, eczema clearance and education) and 48% were emergency admissions (eg acute flares of eczema, psoriasis or cellulitis). The average DLQI score at time of admission was 12 (range 0–30). Three months post-discharge, the average DLQI was 6.5 with an individual average 5.8 point reduction in DLQI score (paired t test, p=0.0001). Improvement in quality of life was greatest in patients with immuno-bullous disease, psoriasis and eczema.
The number of dedicated dermatology beds continues to fall despite evidence of their ongoing need.4 An audit of 280 admissions in Manchester2 over a six-month time period showed that an alternative to admission was only possible in 8.4% of cases. We conclude that designated dermatology ward beds have a significant impact on the quality of life of patients and this effect seems to be sustained for at least three months post-discharge. Inpatient care for dermatological patients remains essential. Ward closures are likely to seriously impact quality of care outcome measures for patients and the future training of healthcare professionals in the specialty.
References
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