TOPLINE:

Implementation of an emergency department (ED)-initiated walk-in dermatology pathway significantly reduced wait times for patients with atopic dermatitis (AD) and hidradenitis suppurativa (HS), and the number of repeat ED visits for pediatric patients with AD.

METHODOLOGY:

• From January 2016 to September 2023, researchers conducted a retrospective chart review of 383 patients aged 21 years or younger who were seen in the ED for AD or HS and had established new dermatology care within 6 months at the Children’s National Hospital in Washington, DC.
• The dermatology division created a walk-in appointment process that began in July 2019 for patients seen in the ED; ED clinicians referred patients with urgent skin concerns — those needing evaluation within 1-2 weeks — to present as walk-ins to the dermatology clinic on Mondays, Wednesdays, or Fridays.
• In the pre-intervention AD cohort (n = 230), the average age was 3.75 years, 43% were female, 60% were Black, and 80% were on Medicaid; in the postintervention cohort (n = 130), the average age was 5 years, 52% were female, 86% were on Medicaid, and 56% were Black. The average age in the HS cohorts was 16 years, most had Medicaid, and the proportions of female (93% vs 56%) and Black patients (79% vs 56%) were higher in the pre-intervention (n = 14) than in the postintervention (n = 9) HS cohort.
• Study outcomes were the time from ED visit to dermatology appointment, the time from dermatology visit to return ED visit, and the number of patients with return ED visits for the same diagnosis within 6 months of establishing dermatology care.

TAKEAWAY:

• Implementation of the walk-in process significantly reduced the average wait times for pediatric dermatology visits for both AD (75.7 days to 19.1 days; P < .01) and HS (89.8 days to 9.3 days; P < .01).
• The proportion of patients with AD with return ED visits within 6 months of establishing dermatology care decreased from 68% in the pre-walk-in cohort to 25% in the post-walk-in cohort (P < .01). The change for patients with HS was not statistically significant.
• The mean interval from the dermatology visit to return ED visit did not change significantly: 79.89 days pre-intervention vs 75.94 days post-intervention for AD; 26.2 days preintervention vs 70.0 days postintervention for HS (P = .40 for both).
• No statistically significant differences were observed in demographics across sex, race, ethnicity, or insurance status between pre- and post-intervention for either the AD or HS cohorts.

IN PRACTICE:

“Our walk-in process decreases the burden on ED clinicians, patients, and dermatologists with no need for care coordination or phone calls to schedule visits,” the authors wrote, noting that this is “especially important for Medicaid patients, who made up a disproportionate number of patients in both cohorts, and traditionally face increased barriers to accessing outpatient specialists.”The creation of “an accessible pathway to establish care with a pediatric dermatologist in a timely manner is essential for managing chronic and complex conditions like HS and AD,” they added.

SOURCE:

The study was led by Jordan K. Bui, Georgetown University School of Medicine, Washington, DC, and was published online on February 17, 2026 in Pediatric Dermatology.

LIMITATIONS:

Limitations of the study included its retrospective, single-center design, and small proportion of patients with HS.

DISCLOSURES:

The authors did not disclose any funding information and declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.