Ophthalmology Emergency Room at the University of São Paulo General Hospital: A Tertiary Hospital Providing Primary and Secondary Level Care

Abstract

emergency room at the University of São Paulo General Hospital: a tertiary hospital providing primary and secondary level care. Clinics. 2007;62(3):301-8. OBJECTIVE:To assess the need for emergency care in a tertiary hospital, in the Ophthalmology Emergency Room of the University of the São Paulo Medical School General Hospital. MATERIALS AND METHODS:A cross-sectional analytic study of the treatment complexity level was carried out in a readily available sample, n = 574, of patients seen at the Ophthalmology Emergency Room of the University of São Paulo Medical School General Hospital, during a typical week. RESULTS: Of the 574 treated patients, 69.0% of the cases were diagnosed as requiring a simple treatment for their problem. The most frequent diagnoses were related to ocular inflammation and infection (55.0%), mainly including conjunctivitis (29.4%) and eyelid inflammations (10.5%). Next in frequency were ocular trauma (19.2%), particularly foreign bodies on the cornea (7.5%) and blunt trauma (5.2%). Refractive errors (3.1%) was the most prevalent diagnosis in the "other ocular modifications" category. CONCLUSION: Most of the cases (69.0%) treated at the Ophthalmology Emergency Room of the University of São Paulo Medical School General Hospital could have been diagnosed and treated in primary or secondary care units. Also, the fact that return visits to check recovery are seen in the ER demonstrates the lack of referral services. The fact that patients come to a tertiary hospital with rather simple cases shows the poor structure of the Brazilian Public Healthcare System, which overloads the tertiary care facilities, where costs for human resources, materials, and other items are higher.

Profile of ocular emergencies in a tertiary hospital from Northeast of Brazil

“…Although the prevalence of inappropriate use reported in the literature varies (7,8) , the results of our study are comparable to studies in other settings which used the same criteria (1,2) . Inappropriate emergency department use is a common problem in various parts of the world and may result in overcrowding, inappropriate utilization of resources, decreased effectiveness of quality of care, increased cost and patient dissatisfaction (23,24) .…”

“…Some tend towards self-medication or simply to request drugs in the drugstore, while others ask for general practitioner or ophthalmology consultations (1,2) . Emergency areas have traditionally provided care to anyone requesting it, including patients with non-urgent complaints.…”

“…Studies describing ocular diseases from the emergency service of a department of ophthalmology are well known and have been reported all over the world (1,(10)(11)(12)(13)(14)(15) . However, limited information is available in Brazil about the medical and social aspects of ophthalmic emergencies (1,2) . Information could be important in the management and planning strategies for prevention and protection of persons with such conditions.…”

Post-visit at ophthalmology emergency service: frequency and perception of the doctors on duty and users

“…The ER of HC-FMUSP received 28.585 patients in the year previous to this research, representing 13.6% of the service of the entire ER HC, counting on with only one ophthalmologist on duty, one resident and one assistant at each shift (12) . Even in this limited setting for a proper doctor-patient relationship, 95.1% of the patients seen at the Ophthalmology ER of HC-FMUSP mentioned that the doctors on duty explained "what had in the visits", and from those 84.0% understood what was explained (Table 3).…”

Artificial tears alone versus 0.45% ketorolac tromethamine with artificial tears for the treatment of acute viral conjunctivitis

“…Four signs were assessed on physical examination: conjunctival hyperemia, conjunc tival chemosis, conjunctival mucus, and the presence of follicles in the lower tarsal conjunctiva. The signs were classified as none (0), mild (1), moderate (2), and severe (3). For conjunctival hyperemia, grade 0 indicated no detectable hyperemia, grade 1 indicated con junctival hyperemia that was barely detectable, grade 2 indicated conjunctival hyperemia that was readily detectable, and 3 indicated intense conjunctival hyperemia that could be mistaken for subcon junctival hemorrhage without slitlamp examination.…”