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Evaluating patient flow through an emergency ophthalmology consult service in a tertiary care academic centre in Quebec

Published:January 23, 2023DOI:https://doi.org/10.1016/j.jcjo.2023.01.004

      Abstract

      Objective

      This study aims to characterize the epidemiology, common reasons, and diagnostic accuracy of referrals made by emergency departments (EDs) and optometrists to an emergency ophthalmology consultation service as well as to identify opportunities for improvement.

      Design

      Retrospective chart review.

      Participants

      A total of 1249 referrals made to the emergency ophthalmology consultation service at a tertiary care centre between July 2018 and June 2019.

      Methods

      Patient charts were examined, and clinical variables were extracted. Statistical significance (p < 0.05) was determined via t tests and χ2 tests for continuous and categorical variables, respectively. Diagnostic accuracy of providers and time delay between referral and ophthalmologic encounter also were assessed.

      Results

      Both EDs and optometrists most often referred cases with vitreoretinal (36.48% and 37.19%, respectively) and corneal pathology (21.42% and 20.25%, respectively). Optometrists (n = 240; 52.48%) were significantly more accurate in their diagnoses than EDs (n = 940; 32.45%; p < 0.00001). Specifically, optometrists were significantly more accurate when diagnosing anterior-chamber (n = 29; 58.62%; p = 0.039) and vitreoretinal (n = 89; 60.67%; p < 0.00001) pathology than EDs (anterior chamber, n = 77, 36.36%; vitreoretinal, n = 344, 18.90%). Across all ED referrals (n = 940), 58 (6.17%) had a prolonged delay. Across all optometrist-to-ED referrals (n = 150), 6 (4.00%) had a prolonged delay. Accounting for all cases, the total incidence of prolonged delay was 5.87%.

      Conclusions

      Our results demonstrate the need for improved communication between optometrists and ophthalmologists to reduce the wait-time burden on EDs. Patients may benefit from direct referral by optometrists to ophthalmologists. Education of allied health professionals on ophthalmic disease also may improve diagnostic accuracy.
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