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Alia Durrani, Murtaza K Adam, Charles M Calvo, Ann P Murchison; Community emergency department referral patterns, diagnostic accuracy, and initial management of patients referred to a tertiary emergency eye care department. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5551.
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© ARVO (1962-2015); The Authors (2016-present)
Dedicated eye emergency departments remain a rare resource in the United States. Availability of ophthalmologic consults for emergency eye care remains a commodity in most community emergency departments. Our dedicated eye emergency department (EED) is located in an urban location, allowing for a large catchment area and referral variety. We performed a prospective, cross-sectional study to examine the referral patterns, initial management, and diagnostic accuracy of referrals to a dedicated eye care emergency department from community providers.
A telephone survey via a transcribed referral line was conducted of referring providers between November 2014 and January 2015. Collected clinical and demographic data was compared to EED documentation. Referrals were excluded from analysis if an attending EED ophthalmologist did not complete a clinical examination. Statistical analysis was performed with SPSS V22.0. Diagnostic agreement between EED physicians and referring providers (MD, RN, NP, PA) was calculated collectively and separately.
Sixty-five referrals were included in our study; 39 of these were from emergency departments and urgent care providers with the remainder from office-based eye care personnel. Overall diagnostic agreement between EED ophthalmologists (OMDs) and referring emergency providers was 27.5%, whereas diagnostic agreement between EED OMDs and eye care personnel was 58.3%. There was a significant difference in visual acuity obtained by referring emergency providers and the EED. Forty-nine percent of referring emergency providers noted availability of on-call OMDs available for consultation, with no patient evaluated by an on-call OMD prior to transfer. Thirty-nine percent of referrals from emergency providers required urgent ophthalmic care.
The proportion of urgent referrals from referring emergency providers highlights the need for access to ophthalmic providers in community settings. Methods to improve on-site ophthalmic care in the community could include increased availability of eye care providers and tele-ophthalmology. The role of mid-level providers in addition to ongoing ophthalmic education for emergency providers should be explored.
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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