Ophthalmic Use of City Hospital Emergency Services

Abstract

 

Purpose

 

To investigate demographics and characteristics of ophthalmology consults in a city hospital emergency department (ED) after the economic recession of 2008.

 

Methods

 

A retrospective chart review was performed to assess the nature of ophthalmic use of a large city ED after the economic recession of 2008. Consults to a busy ophthalmology residency program were reviewed for 2007-2013. The first 10 consults from each month May-August were reviewed as a representative sample of consults received. These months were chosen as they bring in different numbers and types of consults as the new residency year begins (Fig. 1). Results from before and after the recession were statistically analyzed using a z-test for comparison of proportions.

 

Results

 

From 2007-2013, a total of 4245 ED consults were done by the ophthalmology department (Fig. 2). After 2008, the population visiting the ED was predominantly Hispanic (30.8%), Black (25.8%), and white (24.1%). 47.0% had no insurance, 21.7% had Medicaid only, and 9.6% were in police custody. 62.1% of consults walked in, while 24.6% arrived to the ED by ambulance. About one third (33.75%) of the consults were status post blunt trauma; orbital wall fracture was the most common diagnosis (17.9% of consults). 17.1% were called for routine or chronic matters (i.e. dry eye, blepharitis, conjunctivitis, cataract). Only 10% of consults seen were patients previously known to the outpatient clinic. Of the consults, 84.2% were advised to follow up in our outpatient clinic; 67.3% of these patients were lost to follow up before 3 months or completion of treatment. There was no significant difference in these percentages when compared to data from 2007.

 

Conclusions

 

A third of urgently called consults are post-trauma, but a large proportion of consults are called on routine ophthalmic problems. Consults appear unchanged since the recession. Knowledge of the epidemiology and follow-up patterns of consults seen in a city hospital ED can aide in triage, treatment, and patient counseling to encourage follow-up.

 

 

Figure 1: May/June and July/August were chosen as representative months as we tend to see different numbers and types of consults in those months as the seasons and experience of ED residents evolve

 

 

Figure 2: Total ED consults called to ophthalmology per year. * Of note, the ED was closed secondary to Hurricane Sandy from Nov and Dec 2012. **Numbers up until Sept 2013 (further data will be added until the end of 2013).

 

Keywords: 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower • 465 clinical (human) or epidemiologic studies: systems/equipment/techniques • 462 clinical (human) or epidemiologic studies: outcomes/complications