The Use of Telemedicine for Penicillin Allergy Skin Testing

Penicillin skin testing (PST) is increasingly used as a tool to evaluate penicillin allergy in patients with a reported history. The limited availability of allergists, however, may be an impeding factor.

We sought to assess the clinical utility of telemedicine to facilitate PST.

Penicillin-allergic inpatients receiving systemic antibiotics were prospectively identified between April and August 2017. Qualifying patients underwent PST performed by a trained allergy/immunology physician assistant (PA). On completion of PST, a telemedicine consultation, through the use of real-time interactive video conferencing (Microsoft Lync 2013, Redmond, Wash), was performed remotely by an allergist. Patients were surveyed regarding their satisfaction with the telemedicine experience.

Fifty patients consented to PST through a telemedicine consultation. The average total time to complete a consultation was 128 minutes (standard deviation [SD] ± 33). Of this, the average PA travel time was 46 minutes (36%) with the remaining time spent on clinical services (82 minutes, 64%). The average physician telemedicine time per patient was 5 minutes (SD ± 2). Patients rated their experience as an average of 4.5 on a scale of 1 (highly unsatisfied) to 5 (highly satisfied). Of the 46 PST-negative patients, 33 were transitioned to a β-lactam antibiotic that reduced the use of vancomycin, metronidazole, aztreonam, aminoglycosides, and clindamycin (P < .05). More than $30,000 was saved throughout the study period.

Telemedicine is an effective and novel approach to facilitate PST in the inpatient setting and carries a high degree of patient satisfaction. This method has the potential to optimize and improve access to allergy/immunology resources.