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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Article info
Publication history
Published online: January 23, 2023
Accepted:
January 6,
2023
Received in revised form:
December 11,
2022
Received:
September 5,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
