Appropriatezza delle richieste di consulenza dermatologica in Pronto Soccorso in una Azienda Ospedaliera piemontese.

The aim of this study is to evaluate the rate of appropriate use of dermatologist consultants, in order to identify its determinants and to define its economic impact. We analysed 1750 dermatological procedures performed in the emergency room of the Azienda Ospedaliera "Maggiore della Carità" in Novara. The 87,64% of the procedures were inappropriate. We also observed low rates of diagnostic agreement between emergency unit and dermatology unit; 40.88% of discordant diagnoses were due to severe mistakes. The rate of inappropriate dermatological procedures was related to the clinical diagnosis and to patient's access time. The economical analysis was performed using the Activity Based Costing methodology. We measured an average expenditure of euro 7 for procedure (total expenditure euro 9.850). As possible determinants of inappropriateness, we identified the lack of "filter action" by general practitioners, the incorrect behaviour of patients and the professional uncertainty phenomena.