A summary of eye-related visits to a tertiary emergency department

Abstract

Timely ophthalmologic consultation is important to ensure patients receive high quality ophthalmologic care in the Emergency Department (ED). Tele-ophthalmology may prove useful in safely and efficiently managing ED eye-related complaints. Prior to implementing such a solution, current consultation patterns must be understood. We aimed to assess case-mix acuity and consultation workflow patterns in the ophthalmology consult service at a tertiary emergency department in New York City. The medical records of patients with eye-related complaints who presented to the ED between January 1, 2015 and December 31, 2015 were reviewed. Visits were retrospectively assigned acuities and the ophthalmologic subspecialty involved in the case was recorded. The number of ophthalmologic consultations ordered and consultant response times were analyzed. Patients who were transferred to the ED for eye-related complaints were included. The ED received 1090 eye-related complaints in this period. 60% were retrospectively assigned low acuity, 27% were assigned medium acuity, and 13% were assigned high acuity. Ophthalmology was consulted on 19% of low, 18% of medium, and 48% of high acuity cases. 44% of complaints involved the anterior segment and 30% involved oculoplastics. 2/3 of transfer patients initially assigned high acuity were downgraded to low acuity upon examination. On average, the consult note was created and signed within 109 and 153 min, respectively, after consult order. ED consults are heavily weighted towards pathology of low-to-medium acuity affecting the anterior segment and ocular adnexa. Currently available tele-ophthalmology technology can potentially address a large volume of eye-related visits.

Profile of Eye-Related Emergency Department Visits in Ontario – A Canadian Perspective

“…[9,15,16] This nding is similar to previous literature which has demonstrated that between 44% and 60% of ophthalmic presentations to the ED were for nonemergent problems. [14,17] In this investigation, 87% of patients reported having access to a primary care provider; systems level changes to help redirect patients with nonurgent presentations to more appropriate care can help with ED overcrowding. [18,19] The results of this investigation are of particular importance given the increase in burnout seen by ED providers from the COVID-19 pandemic.…”

“…These results are in-keeping with previous investigations which have similarly demonstrated anterior segment pathology to be most frequent impetus for patient presentation to the ED. [17,22,23] As such, approaches to frequent corneal and external eye conditions should be a signi cant focus of emergency medicine teaching. Recognizing emergent vision threatening presentations and when to consult ophthalmology should instead be the focus for presentations that are less frequent.…”

A Syringe in an Emergency Saves Time: An Audit on the Utility of Syringe Provision in Eye Emergency

“…Corneal abrasions and foreign bodies on the ocular surface are two of the most common ophthalmic complaints of patients presenting to the emergency departments [ 1 ]. Some ocular complaints, although not emergent, can cause extreme discomfort to the patient, whereas other problems can be vision threatening and require immediate ophthalmological consultation [ 2 ]. The cornea is richly innervated, hence corneal foreign bodies can present with symptoms like pain.…”

Eye irrigation as a first-line treatment and diagnostic method for emergency department patients who complain of ocular foreign bodies

“…Among patients visiting EDs with ophthalmic primary complaints, corneal abrasions and foreign bodies (FBs) on the ocular surface are among the leading diagnoses, and these two diagnoses respectively represent approximately 13–14% and 8–15% of the complaints 4 , 5 . These patients probably visited the ED because of persistent ocular FB sensation and concerns that a FB remained inside the eye.…”

“…These patients probably visited the ED because of persistent ocular FB sensation and concerns that a FB remained inside the eye. However, a recent report from New York City revealed that the time from triage to completion of an ophthalmologic consultation for patients complaining of FB sensation was long: 174–263 min 5 .…”