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Levi Kanu, Daniel Oh, Judy Chen, Ahmad Aref, William F Mieler, Peter MacIntosh; Ophthalmology consultations at an academic hospital. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5440.
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© ARVO (1962-2015); The Authors (2016-present)
Hospital consultation services are important for optimal patient care and are integral to residency education programs. In-hospital consultations present unique diagnostic, treatment, and logistical challenges with which the ophthalmologist should be familiar. The purpose of this study was to characterize the inpatient and emergency room consultations managed by an ophthalmology consultation service.
Prospective study of all inpatient and emergency room consultations received by the ophthalmology residency consultation service at the University of Illinois at Chicago Hospital over the course of twelve months. Consultation details including chief complaint, consulting team, ophthalmologic diagnosis, and in-hospital evaluation suitability were collected for each consultation. Consultations more suitable for outpatient evaluation met the following criteria: (1) no acute ophthalmic symptoms, (2) no possible change in inpatient management, and (3) inpatient evaluation would be inferior to outpatient evaluation.
581 ophthalmology consultations were received, for an overall consultation rate of 2.70 consultations per day. Median age was 47-years-old (range 0 to 87). The most common consulting services were emergency medicine (40.6%), internal medicine (21.5%), and neurosurgery (16.2%). Ophthalmic subspecialties most commonly implicated in consultations were neuro-ophthalmology (47.8%), retina (29.7%), and cornea (11.0%). The most common chief complaints were vision change (30.3%), eye pain (19.8%), and periorbital pain and/or swelling (12.0%). Most consultations were for acute issues (71.9%). Of the non-acute consultations, 22.3% were for chronic problems while the remainder were for screening examinations. 19.0% of the non-acute consultations were found to be more suitable for outpatient evaluation. The most common reasons for non-essential consultation included pre-operative confrontational visual field (CVF) testing for known central nervous system tumors (47.7%) and baseline pediatric examination (18.2%).
A wide range of consulting services and consultation indications may present to the in-hospital ophthalmology consultation service. A substantial portion of consultations may be more suitable for outpatient evaluation, and characteristics of such consultations may be used to guide residency education on consultation triage.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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