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A. F. Braganza, A. Meleth, B. Edgington; Characterization of Emergency Room Ophthalmic Consults in an Academic Hospital and the Effect of an Instructional Video on Consultation Requests. Invest. Ophthalmol. Vis. Sci. 2008;49(13):627.
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Primarily, to characterize ophthalmology consults requested by the emergency room of an academic hospital with a focus on the rate and nature of interventions required, as well as the eventual diagnosis. Secondly, to determine the effect of an instructional video produced for the ER staff on the nature of ER consultations requested and appropriateness of patient care.
Retrospective chart review was performed of all ophthalmic consults performed in the emergency room at George Washington University Hospital from 07/29//2005-01/14/2007. Patients sent directly from the ED to the clinic were not included. The data collected were chief complaint, visual acuity, intraocular pressure, diagnosis, whether an intervention was required, and the nature of the intervention. Following this analysis, an instructional video was produced in collaboration with the ER residency program. The goal of the video was two-fold: first, to review the clinical characteristics of the most common ocular complaints to the ER and second, to provide instruction on the basic operation of the slit lamp and the diagnostic techniques necessary to make the appropriate diagnosis. A survey was given to the ER staff prior to viewing the video and 2-3mos afterwards to determine if the video was useful to their management of ocular complaints.
209 consults were included in the review. 56% of the patients were male, with a mean age of 43.2, range 15-96. 76.5% (160/219) required some form of intervention, while 30/160 required surgical/procedural intervention, representing 14% of all consults. 52% (107/209) of consults involved trauma, and 48.6% (52/107) of these traumas were secondary to assault. 34/107 (32%) of all traumas carried an eventual diagnoses of orbital fracture. There was no significant difference in the characterization of consults received after the instructional video intervention.
Traumatic complaints are responsible for a large percentage of emergency room ophthalmic consultations. Overall, emergency room consultations require a higher level of intervention than inpatient consultations. Providing an instructional video to the ER staff did not seem to have a significant impact on the type of ophthalmic consults requested. However, the majority of survey respondents considered the video a useful tool.
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