Emergency Department Ophthalmology Consultations in a Tertiary Care Hospital

Abstract

Objective The main objective of this article is to characterize ophthalmology consultations in the emergency department (ED) of a tertiary care hospital and identify specific ways to modify the curriculum for ophthalmology and emergency medicine residency programs to train residents to effectively manage eye-related consultations.

Design This is a retrospective chart review study of ED encounters between January 1, 2008 and January 1, 2017 during which ophthalmology was consulted.

Setting Single-center urban tertiary care center.

Participants All adult patients who were seen by the ophthalmology consultation service in the ED during the study time period.

Main Outcome Measured We identified the reason for and timing of ophthalmology consultation; diagnoses made in the ED and follow-up ophthalmology clinic visit; procedures resulting from consultation; and communication with a senior resident, fellow, or attending.

Results We identified 3,583 consecutive ED encounters with an ophthalmology consultation over a 9-year period. About 51.1% of patients were female and mean age of patients was 49 years. Blurry vision/vision loss was the most common reason for consultation (24.8%) and posterior vitreous detachment was the most common diagnosis made in the ED by the ophthalmology team (11.0%). Of the patients with documented follow-up ophthalmology clinic visits, 96.7% of diagnoses made at the first ophthalmology clinic visit were the same as those determined in the ED. About 12.7% of visits resulted in a procedure with the most common being eyelid laceration repairs, pars plana vitrectomy, and laser retinopexy. Overall, 40.4% of visits required communication with a senior resident, fellow, or attending. The frequency of residents seeking assistance from more senior ophthalmologists decreased over the course of the academic year (p < 0.0001).

Conclusions This study provides data that ophthalmology residency training programs can use to more effectively prepare residents for consultations in the ED. Furthermore, identifying the reasons for consultation and subsequent diagnoses can guide the education of emergency medicine physicians to improve their ability to diagnose and triage ophthalmologic presentations.

Keywords

ophthalmology consults - residency - emergency department

Note

Presented at the Association for Research in Vision and Ophthalmology Annual Meeting, 2018.

Authors' Contributions

Authors M.J.H., S.K., D.G., S.A., S.E.E., P.J.B. had full access to all the data in the study. M.J.H. and S.K. take responsibility for the integrity of the data and the accuracy of the data analysis. P.J.B. made significant contribution in writing and editing.

• References

• 1 Vaziri K, Schwartz SG, Flynn Jr HW, Kishor KS, Moshfeghi AA. Eye-related emergency department visits in the United States, 2010. Ophthalmology 2016; 123 (04) 917-919
• 2 Channa R, Zafar SN, Canner JK, Haring RS, Schneider EB, Friedman DS. Epidemiology of eye-related emergency department visits. JAMA Ophthalmol 2016; 134 (03) 312-319
• 3 Stagg BC, Shah MM, Talwar N, Padovani-Claudio DA, Woodward MA, Stein JD. Factors affecting visits to the emergency department for urgent and nonurgent ocular conditions. Ophthalmology 2017; 124 (05) 720-729
• 4 Busca P, Cancio M, Aginaga JR, Marcellán C, Ventura I, Miró Ó. Analysis of the characteristics of interconsultations performed by emergency physicians to other hospital specialists and their evolution over time. Eur J Emerg Med 2014; 21 (05) 341-348
• 5 Coffee RE, Westfall AC, Davis GH, Mieler WF, Holz ER. Symptomatic posterior vitreous detachment and the incidence of delayed retinal breaks: case series and meta-analysis. Am J Ophthalmol 2007; 144 (03) 409-413
• 6 Rizzuti AE, Vastardi M, Hajee M, Lazzaro DR. Scope of resident ophthalmology consultation service and patient follow-up rates at a level 1 trauma center in Brooklyn, New York. Clin Ophthalmol 2013; 7 (March(: 643-647
• 7 Dong CQ, Farhat B, Kruh JN. . Patterns of follow up after emergency room ophthalmic consultation. In: 2018. https://ep70.eventpilot.us/web/page.php?nav=false&page=IntHtml&project=ARVO18&id=2921810 . Accessed May 29, 2018