The urgent need to develop emergency EYE care in the UK: the way forward?

Barnes, Beth; Cassels-Brown, Andy; Chang, Bernard; Harcourt, Jane; Pilling, Rachel; Shickle, Darren; Spencer, Anne Fiona; Vernon, S; MacEwen, C J

doi:10.1038/eye.2017.113

Cited by 10 publications

(10 citation statements)

References 19 publications

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“…Compared to the ONS data, our results showed that the largest proportion of patients accessing HEECS were between those aged 50–90 years. This in part can be explained by the increased presentations of ocular emergencies in the older age groups such as vitreoretinal, retinal vascular and macular disorders [ 5 , 12 , 13 ]. After adjusting for the population differences within each age group, the highest attendance rate was observed in the 80–84-year age group.…”

Section: Discussionmentioning

confidence: 99%

“…London’s two largest HEECS units, Moorfields Eye Hospital and the Western Eye Hospital, have reported an increase in annual attendance by 7.9% and 9.6% per year respectively [ 2 , 3 ]. The increase in attendance in HEECS have been attributed to (a) increasing population size and ageing demographic, (b) further indications for treatment, (c) defensive medico-legal practice amongst community practitioners [ 4 ], (d) changes to service accessibility and (e) patient health-seeking behaviours [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Access to HEECS is predominantly available during extended outpatient clinic hours. Outside of these hours, patients often have access to on-call services [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Patterns of attendances to the hospital emergency eye care service: a multicentre study in England

Silva

Thomas

Shirodkar

et al. 2021

Eye

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Patterns of attendances to the hospital emergency eye care service: a multicentre study in England

Silva

Thomas

Shirodkar

et al. 2021

Eye

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“…Should the demand for community nursing support outstrip the capacity of that service, then patients may be left receiving inadequate levels of post-operative medication -an involuntary non-compliance adding to the existing matrix of factors promoting non-compliance (Dury, 2013) which could result in patients with excessive inflammation presenting to emergency services, who in turn may have limited capacity to absorb this additional requirement. (Buchan et al, 2017b) Interventions that promote efficient use of resources such as this are not primarily about saving money, but about releasing the finite capacity of health care services to engage with the care activities that offer the best value. Cost-cutting can be counter-productive in some instances, (Jones, 2015) however in a setting where sufficient visits to administer the full course of eye drops cannot be supported, this depot steroid injection option could offer superior post-operative inflammation control at a lower price.…”

Section: Discussionmentioning

confidence: 99%

Post-cataract eye drops can be avoided by depot steroid injections

Cleveland

Sutton

Cassels-Brown

2017

Br J Community Nurs

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There are over 400,000 cataract operations now being performed annually in the UK. With the majority of those patients being elderly, co-morbidities such as dementia or arthritis can prevent patients putting in their own post-operative eye drops. Where there is a lack of family or other support, district nursing services are often called upon to administer these eye drops, which are typically prescribed four times a day for four weeks, thus potentially totalling 112 visits for drop instillation per patient.To reduce the burden of these post-operative eye drops on district nursing services, administration of an intra-operative sub-tenons depot steroid injection is possible for cataract patients who then do not require any post-operative drop instillation. As a trial of this practice, sixteen such patients were injected in one year, thus providing a reduction of 1792 in the number of visit requested. Taking an estimated cost of each district nurse visit of £38, this shift in practice potentially saved >£68,000; the additional cost of the injection over the cost of eye drops was just £8.80 for the year. This practice presents an opportunity to protect valuable community nursing resources, but advocacy for change in practice would be needed with secondary care, or via commissioners. Key WordsCataract, cataract surgery, ophthalmic solutions, community health nursing Key Points-Cataract surgery is the most common surgical intervention in the UK -With the ageing population, a growing number of patients are unable to instill their own eye drops post operatively and require district nursing support -A depot steroid injection intra-operatively removes the requirement for postoperative drops, thus permitting redeployment of valuable district nursing resources

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“…Eye-related problems are a common reason for emergency department (ED) visits, and the frequency of such visits is increasing 1 . In 2010, 1.5% of patients visiting the EDs in the United States received an ophthalmic principal diagnosis, and, between 2000 and 2015, 2–3% of patients discharged from the EDs in Taiwan received diagnoses of eye-related injuries 2 , 3 .…”

Section: Introductionmentioning

confidence: 99%

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

Chou

Chen

Kang

et al. 2021

Sci Rep

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This prospective study aimed at determine whether eye irrigation removes ocular foreign bodies (FBs) and whether ocular pain predicts FBs. Emergency department patients complaining of ocular FBs were enrolled. In the irrigation group (n = 52), pain was evaluated with a visual analog scale before and after irrigation, and the presence of FBs was determined under a slit-lamp. In the nonirrigation group (n = 27), the evaluations were performed upon arrival. The corneal FB retention rate was found significantly lower in the irrigation (13/52, 25%) than in the nonirrigation groups (13/27, 48%; P = 0.04). After irrigation, those without FBs had more patients experiencing pain reduction (67%) compared to those with retained FBs (46%; P = 0.14) and had a greater magnitude of change in pain score (mean ± SD, − 2.6 ± 2.7 vs. − 0.7 ± 1.4; P = 0.02). An improvement in ocular pain score ≥ 5 points after irrigation predicted the absence of FBs with a negative predictive value of 100%. Eye irrigation significantly lowered corneal FB retention; if ocular pain decreased considerably, the probability of retained FBs was low, making irrigation-associated pain score reduction a feasible diagnostic method to exclude FB retention without needing specialized ophthalmic examinations.

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The urgent need to develop emergency EYE care in the UK: the way forward?

Cited by 10 publications

References 19 publications

Patterns of attendances to the hospital emergency eye care service: a multicentre study in England

Patterns of attendances to the hospital emergency eye care service: a multicentre study in England

Post-cataract eye drops can be avoided by depot steroid injections

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

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