Nurses in outpatient settings face challenges balancing heavy patient caseloads while accommodating unplanned acute visits. Nurses also spend significant time triaging patients' symptoms on the telephone. Patients often find it difficult to accurately describe symptoms, and without accompanying images, unnecessary office visits are scheduled. Teledermatology
, involving the exchange of digital images remotely between patient and provider, has shown promise in accurately triaging patients and decreasing unnecessary visits. At one outpatient dermatology site at a multisite comprehensive cancer center, a 6-month performance improvement initiative was conducted to evaluate the effectiveness of teledermatology
using an electronic patient portal. Nurses instructed prescreened patients to send digital images via the portal. On the basis of image appearance and patients' symptoms, nurses provided assessment and education over the phone, and patients either kept their future appointments or came in for an earlier evaluation. More complex cases were escalated to the physician. This initiative reduced the number of unnecessary patient visits, which opened more visit slots for those with acute issues. Teledermatology
improved overall efficiency of care, and patients and clinicians have reported satisfaction with the process.