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Cecilia Qianwen Dong, Jonathan Kruh; Why don’t patients follow up after an emergency room ophthalmic consultation? – An assessment of risks factors. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5084.
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Many patients who present to the emergency department (ED) with an ophthalmologic emergency fail to follow up after initial ED consultation. We identified risk factors unique to ophthalmology that predict subsequent follow-up in patients evaluated by the Ophthalmology service in ED at Jamaica Hospital Medical Center (JHMC), a level I trauma center in Queens, New York.
This is a retrospective review of electronic medical records of patients who were evaluated by Ophthalmology in the ED in 2012-2015. We included men and women over the age of 18 who were residents of New York State. Minors and those with no follow up recommendations were excluded. In total, 311 patients were reviewed and 187 included in the study. Covariates studied were: age, gender, employment status, insurance status, previous relationship with the hospital, diagnosis, visual acuity and presence of visual disturbance. Primary outcome measured was the pattern of follow up: timely follow up (within 48 hours of recommended), delayed (over 48 hours of recommended), and no follow up. Regression, one-way ANOVA, and Chi-square tests were used to determine association between covariates and outcome.
Of the 187 patients included, 35.8% (CI 7.3%) had timely follow up, 58.0% (CI 8.0%) failed to follow up, and the remaining 6.2% with delayed follow up. Of those with self-reported visual disturbance, 45.7% followed up as recommended, in contrast to 28.3% when there was no visual disturbance (z=2.295, C=1.96, p<0.05). In addition, more patients (47%) followed up when given shorter follow-up interval of less than three days, vs 24% when recommended follow-up was seven days or longer. Furthermore, if the patient had any previous encounter with any department at JHMC, he or she was more likely to be compliant, with 47.7% following up compared to 30.2% if the patient had no previous relationship with the hospital (z=2.12 C=1.96, p<0.05). Older female patients and those with medical insurance were also more likely to have timely follow up.
In our patient population, more than half of all patients with an eye emergency are lost to follow up. We have identified factors that affect follow up, some consistent with previous emergency medicine literature and some unique to ophthalmology. Understanding these factors will allow us deliver better care to our patients by increasing compliance with follow up.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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