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Michael J Heiferman, Saira Khanna, David Gu, Samantha Agron, Sarah Eichinger, Paul Bryar; Emergency Department Ophthalmology Consultations in a Tertiary Care Hospital. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5250.
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© ARVO (1962-2015); The Authors (2016-present)
Consultation services are an important component of residency training programs. The emergency department (ED) is one of the main settings for ophthalmology consultations. We performed a retrospective, chart review in order to identify the most common reasons for consultation, diagnoses, recommendations for follow-up, and correlation between follow-up diagnosis and initial ED diagnosis. By characterizing these consultations, we hope to inform improvements in residency training curricula.
The Northwestern Medicine Enterprise Database was used to identify all ED encounters at a single tertiary care hospital during which ophthalmology was consulted. Between January 1, 2014 and January 1, 2017 there were a total of 1598 encounters.
Of the 1598 encounters, there were 152 unique diagnoses. The top 3 reasons for consultation were vision changes (24.1%), eye pain (17.5%), and flashes/floaters (15.0%). The most common diagnoses made by the consulting ophthalmologist in the ED were posterior vitreous detachment (9.6%), orbital fracture (9.2%), and normal eye exam (8.3%). 706 (44.2%) encounters resulted in a follow-up visit at the Northwestern outpatient ophthalmology clinic within 3 months. 547 (77.5%) diagnoses made during the initial follow-up visit were the same as the original diagnosis in the ED. 71.6% of the ED ophthalmology consultations were outside of business hours, 16.8% of patients were admitted, and 12.1% of consultations resulted in a procedure. Of these procedures, 53.4% were done in the ED, 15.0% were done in the operating room, and 30.6% were done at follow-up. There were 26 different procedures performed with the most common being eyelid laceration repair (19.6%), pars planta vitrectomy (15.0%), foreign body removal (11.9%), and laser retinopexy (9.3%).
By identifying the most common reasons for ophthalmology consultation in the ED, diagnoses made, recommendations for follow-up, and procedures performed, this study provides data that residency training programs can use to more effectively prepare residents for consultations in the ED. Furthermore, identifying the reasons for consultation and subsequent diagnoses can guide the education of emergency physicians to improve their ability to diagnose and triage ophthalmologic presentations.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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