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- Presentation
Optimizing Total Body Skin Exam Scheduling with a Risk-Based Triage Calculator
Description
The presentation describes a quality improvement project at Northwestern aimed at optimizing scheduling for total body skin exams (TBSEs) by using a risk-based triage calculator. The team identified three main problems: there are no clear guidelines or consensus on who should receive TBSE screening, demand for TBSEs appears to be rising even among low-risk patients, and access is limited with long lead times for new appointments. To understand current practice, they mapped the scheduling workflow, reviewed 2024 TBSE visit data from nearly 99,000 visits, and found that only 12.64% led to biopsy. In multivariate analysis of new patient visits, older age, male sex, white race, and history of non-melanoma skin cancer or combined melanoma/NMSC were associated with higher biopsy odds, while melanoma history was clinically important despite not being statistically significant. Based on these findings, they propose integrating a weighted risk calculator into the MyChart scheduling algorithm so higher-risk patients are directed toward TBSE appointments and lower-risk patients may be steered to lesion checks or other pathways. Planned outcomes include biopsy rate, appointment distribution by risk category, lead time, and unfilled slots, with further data analysis and stakeholder feedback underway before implementation.
View moreConclusions
- The department concluded that total body skin examinations are currently being used without clear evidence-based guidance on who truly benefits most.
- The existing scheduling system appears to funnel many patients with low-risk screening needs into TBSE pathways, contributing to long wait times and inefficient use of clinic capacity.
- A substantial share of TBSE visits are for older, white, male patients and patients with a prior skin cancer history, suggesting these characteristics are associated with higher biopsy yield.
- Among new patients, a history of non-melanoma skin cancer was the strongest predictor of biopsy, while melanoma history was less clearly associated statistically but still seemed clinically important.
- The team concluded that a risk-stratified scheduling tool could better prioritize higher-risk patients for TBSE access and redirect lower-risk patients toward lesion checks or other pathways.
- Their proposed intervention is to embed a point-based risk calculator into MyChart triage so appointment type and availability are matched to estimated risk.
- Success will be judged not just by biopsy yield, but also by process measures such as MyChart use, risk-slot allocation, appointment fill rates, and reduced lead time for higher-risk TBSEs.
- Overall, the project concludes that optimizing TBSE access will require iterative quality improvement, more longitudinal data, and stakeholder buy-in before full implementation.
- Lee et al., 2023
- Tsang & Resneck, 2006
- Rangachari, 2023
- Source: Louisiana Department of Health. https://ldh.la.gov/page/5357. Accessed March 13, 2026.
- Taylor et al., 2014