Cost and Visit Duration of Same-Day Access at an Academic Ophthalmology Department vs Emergency Department

Abstract

IMPORTANCE Convenient outpatient access for ophthalmology patients seeking urgent care could offer savings compared with an emergency department (ED) visit. OBJECTIVE To evaluate the costs and visit durations of same-day access (SDA) in an ophthalmology department at an academic medical center vs ED care. DESIGN, SETTING, AND PARTICIPANTS This single-center study was a retrospective quality improvement analysis of an institutional electronic medical record system at the Wilmer Eye Institute clinics and the Johns Hopkins Hospital ED. On June 1, 2015, the Wilmer Eye Institute and Johns Hopkins Hospital initiated an official policy of providing SDA to patients calling for appointments (ie, the same-day project). All ophthalmology clinic locations created same-day appointment slots for at least 1 practitioner. In recognition of seasonal variations in patient visit volumes, the 10 months before implementation (August 1, 2014, to May 31, 2015) were compared with complementary periods in 2015 to 2016 and 2016 to 2017. MAIN OUTCOMES AND MEASURES The study tabulated encounters, charges, and visit length for outpatients seen on the same day or by previously scheduled appointments. For the ED patients, volume, diagnoses, charges, and length of stay data were collected. The numbers of SDA patients who indicated urgency were tabulated.

Healthcare disparities contribute to missed follow-up visits after cataract surgery in the USA: results from the perioperative care for intraocular lens study

“… 32 Moreover, as vision improves and complaints such as eye discomfort and redness are diminished, a postoperative visit is more likely to be perceived as unnecessary. 32 …”

“…20 23 30 31 Patients are less able to plan effectively long-term, 16 and are more likely to forget or seek care elsewhere. 32 Moreover, as vision improves and complaints such as eye discomfort and redness are diminished, a postoperative visit is more likely to be perceived as unnecessary. 32 Gupta et al found a linear association of visual acuity and follow-up compliance, with patients having better visual outcomes demonstrating more adherence.…”

“…32 Moreover, as vision improves and complaints such as eye discomfort and redness are diminished, a postoperative visit is more likely to be perceived as unnecessary. 32 Gupta et al found a linear association of visual acuity and follow-up compliance, with patients having better visual outcomes demonstrating more adherence. 15 On Open access the contrary, in our cohort, better visual acuity at the previous visit was associated with a higher rate of subsequent missed appointments, except for patients with very low vision who exhibited the highest rate of nonattendance, even after controlling for confounders.…”

Utilization trends of an ophthalmology-specific emergency department: the Massachusetts Eye and Ear experience

“…The Wilmer Eye Institute of Johns Hopkins Hospital has improved such access by implementing the Same-Day project in 2015, in which all ophthalmology clinic locations created same-day appointment slots for at least 1 practitioner. 15 The project, which is ongoing, did not require hiring of additional personnel to accommodate patients. 15 A retrospective quality improvement analysis of the Same-Day project found that a patient with a nonemergent eye concern would save $782 in charges and 5.75 hours in visit duration by choosing the same-day outpatient care rather than an emergency department visit.…”

“…15 The project, which is ongoing, did not require hiring of additional personnel to accommodate patients. 15 A retrospective quality improvement analysis of the Same-Day project found that a patient with a nonemergent eye concern would save $782 in charges and 5.75 hours in visit duration by choosing the same-day outpatient care rather than an emergency department visit. Major eye centers, such as MEE, could implement a similar project with the goal of saving money and time.…”