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Dilraj S. Grewal, Elizabeth Chiang, Elizabeth Wong, Nicholas J. Volpe, Paul Bryar; Adult Ophthalmology Inpatient Consults at a Tertiary Care Teaching Hospital. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1411.
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To describe the characteristics of ophthalmology inpatient consultations performed at a large adult urban tertiary care teaching hospital.
A retrospective review of electronic health records of inpatient ophthalmology consultations was performed. Using the Northwestern Medical Enterprise Data Warehouse, an integrated repository of medical data sources, patients with an inpatient ophthalmology consult were identified. Electronic data including free text of consult note, reason for consultation, consulting service, ophthalmologic diagnoses and management plans, need for additional ophthalmic subspecialty consults, number of inpatient ophthalmic visits and patient demographics were assessed.
Four hundred and four consultations were analyzed. The most common reasons for consult were blurred vision (13.4%), red eye (10.1%), orbital fracture (7.5%), rule out fungal endophthalmitis (4.5%) and diplopia (3.9%). 79.7% of consults were initiated due to a patient complaint and 20.3% were to confirm presence or absence of a disease or ocular finding. The most common ophthalmic diagnosis were; normal exam (13.3%), orbital fracture (8.6%) corneal abrasion (5.1%), dry eye (4.9%), subconjunctival hemorrhage (4.2%) and preseptal cellulitis (3.6%). 83.7% of consults had a dilated exam at least once during the consultation. Ophthalmic management was initiated in 200 (49.5%) patients, consisting mostly of eye drops (122 patients), systemic medications (16) diagnostic imaging or testing (28) and procedures (12). Each consult required an average of 1.4 (range 1-9) visits while in house. 1/18 (5.5%) of consults to rule out fungal endophthalmitis were positive and 0/8 consults to rule out CMV retinitis were positive. Ophthalmic subspecialties were consulted in 15 (3.7%) patients; Neuro-ophthalmology (4), Retina (5), Uveitis (2), Glaucoma (2) Cornea (1) and Oculoplastics (1). The most common services requesting consult were Medicine (28.3%), Neurosurgery (13.1), General Surgery (10.1%), Hematology-Oncology (9.4%) and Neurology (9.2%).
Ophthalmologic consultation is a valuable inpatient service utilizing multiple ophthalmic subspecialists to help address a variety of clinical issues. Input from ophthalmology changed or added to the management plan in half of all consults. Analyzing the characteristics of inpatient ophthalmology consultations is useful for the planning and allocation of appropriate resources to effectively manage a consult service. Knowing the nature of common consultations will help residency programs identify areas in need of targeted education.
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