September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Triaging Ophthalmic Emergencies: A 4-Parameter Tool embedded in an Emergency Department’s Electronic Health Record System
Author Affiliations & Notes
  • Farhan Merali
    Cornea and External Disease, Wilmer Eye Institute, Baltimore, Maryland, United States
  • Oliver Schein
    Cornea and External Disease, Wilmer Eye Institute, Baltimore, Maryland, United States
  • Stephanie Figueroa
    Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Peter Pronovost
    Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Mustapha Saheed
    Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Rose Johnson
    Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Tina Tolson
    Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Peter Hill
    Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Michael Peter Grant
    Ophthalmic Plastic and Reconstructive Surgery, Wilmer Eye Institute, Baltimore, Maryland, United States
  • Shameema Sikder
    Cornea and External Disease, Wilmer Eye Institute, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Farhan Merali, None; Oliver Schein, None; Stephanie Figueroa, None; Peter Pronovost, None; Mustapha Saheed, None; Rose Johnson, None; Tina Tolson, None; Peter Hill, None; Michael Grant, None; Shameema Sikder, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 5541. doi:
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      Farhan Merali, Oliver Schein, Stephanie Figueroa, Peter Pronovost, Mustapha Saheed, Rose Johnson, Tina Tolson, Peter Hill, Michael Peter Grant, Shameema Sikder; Triaging Ophthalmic Emergencies: A 4-Parameter Tool embedded in an Emergency Department’s Electronic Health Record System. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5541.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To assess the reliability of a 4-parameter triaging system embedded in the electronic health record (EHR) system in predicting ophthalmic urgency when conducted by emergency department (ED) nurses.

Methods : A 4-parameter triaging system previously found to be highly reliable in detecting urgent ophthalmic pathology at an ophthalmic ED was adapted for use by non-ophthalmic providers: (1) Descriptive and visual guidelines for use were developed, and (2) The triaging system and developed guidelines were embedded into the ED's EHR. All patients presenting to the ED with an ophthalmic complaint were assigned a score between 0 and 12 by an ED triaging nurse that assessed the patient’s presentation in four categories: eye redness, eye pain, risk of open globe, and vision loss. Color coding was assigned based on the cumulative triaging score: 0–3 was classified as green, 4–7 as yellow, and 8–12 as red. The triaging score was compared against the ophthalmic consultant’s assessment in the same categories and assigned diagnosis.

Results : During the study period, 250 patients were assessed. Of these, 72 (28.8%) patient presentations were classified as urgent (a code of yellow or red), with the remainder classified as non-urgent. Patients were triaged using the tool within 9.1 ± 5.3 minutes of arriving at the ED. The sensitivity of the system was 0.958(95% CI 0.88-0.99) and specificity 0.781(95% CI 0.71-0.84). The correlation between urgency level as coded by triage nurses and eye care providers was significant with a Spearman’s rank coefficient 0.67 (P<0.0001): 82.0% patients were coded at the identical level of urgency by both providers; 6.0% were undercoded by one category level, 11.6% were overcoded by one category level, and 0.4% were overcoded by two category levels.

Conclusions : The triaging tool as administered by ED nurses using the guidelines developed is a simple, rapid and highly sensitive method of detecting urgent ocular pathology. Such a system holds the potential to decrease the cost of eye care to patients and the health care system more broadly. By reliably referring patients with non-urgent ocular conditions to outpatient appointments in collaboration with ophthalmic providers, wait times and length of stay may be considerably reduced for all-comers, while valuable and costly ED resources would be conserved for patients with truly urgent conditions.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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