Improving Same-Day Access in Ophthalmology

Abstract

Timely health care access has assumed increasing importance to consumers and practitioners. We are all aware of individuals who want their care when and where it is convenient. We are thus witnessing an increase of walk-in clinics, urgent care centers, afterhours clinics, and free-standing emergency departments (EDs). In ophthalmology, the desire of patients to be seen at their convenience has been compounded by an aging population and increased demand for services because most ophthalmologists are busy and have minimal capacity to add patients to their practices.Obtaining eye care in an ED creates challenges for patients and practitioners. For patients, ED visits often involve significant wait times and higher costs; on many occasions in the ED, care is delivered by a practitioner who is not residency trained in ophthalmology (because most EDs do not have ophthalmologists on staff). For the busy ophthalmologist, it may be challenging to see a patient in the ED, particularly given the limited examination equipment. Furthermore, payers have become increasingly aware of the extra costs associated with ED visits; recently, Anthem Inc instituted a policy to deny payment for visits that it deemed to be unnecessary. 1 Thus, several factors contribute to a need to add same-day appointments in ophthalmology.Approximately 5 years ago, the Department of Ophthalmology at the Wilmer Eye Institute began to offer same-day access as a pilot project in their resident clinic. After a positive response to the pilot project, the department initiated a mandated, formal, department-wide same-day access initiative on June 1, 2015: each of the 9 Wilmer Eye Institute clinic locations had same-day appointments available with at least 1 practitioner, and the centralized call center offered these appointments to patients who called to request care. The results of this initiative from a retrospective review of clinic and ED volumes before and after that date are reported by Singman et al. 2 Estimated costs were also compared. The article 2 adds to previous reports 3-6 that have helped us understand how to improve patient flow in a busy academic ophthalmology practice. These data have been associated with the incorporation of electronic medical record systems and may represent another potential advantage of such systems in practice management.The authors describe the consequences of this initiative by reporting the change in same-day access visits, the mean same-day access visit appointment length, and the number of ophthalmic visits to the Johns Hopkins Hospital ED before and after the mandate. They reported that patients seen in the clinic had lower charges and lower visit times than those seen in the ED. The authors found that this initiative produced increased outpatient ophthalmology volumes and that clinic care cost less on average than ED care.

Evaluation of Interventions Targeting Follow-up Appointment Scheduling After Emergency Department Referral to Ophthalmology Clinics Using A3 Problem Solving

“…Other medical centers have addressed the challenge of timely outpatient services by offering same-day appointment slots at their ophthalmology clinics. 33,34 While this reduces the need for urgent follow-up from the ED, it does not eliminate it because some eye care emergencies occur outside of clinic operating hours and patients may not be aware of what requires immediate attention and what can wait for same day outpatient care. 1,3,35 Limitations A limitation of this project is that causal impact of the interventions cannot be proven owing to lack of a comparison without intervention.…”

“…Similarly, authorization to waive charges for outpatient care would require institutional-level policy changes. Other medical centers have addressed the challenge of timely outpatient services by offering same-day appointment slots at their ophthalmology clinics . While this reduces the need for urgent follow-up from the ED, it does not eliminate it because some eye care emergencies occur outside of clinic operating hours and patients may not be aware of what requires immediate attention and what can wait for same day outpatient care …”

The effects of the Covid-19 pandemic on eye-related emergency visits

“…In several health services, it is not an ophthalmologist who performs the first care, and most of the general doctors are not prepared to provide adequate ocular treatment and management, which can lead to loss of the patient's visual capacity. (1,2) The first cases of a respiratory failure of unknown cause were reported in Wuhan, Hubei, China, in December, 2019, but it was only in March 2020 that the World Health Organization (WHO) declared a state of global pandemic caused by this new entity named coronavirus disease 2019 . Covid-19 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), whose transmission occurs mainly through the contact with contaminated people or surfaces.…”