June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Emergency Department Utilization of Ophthalmology Services
Author Affiliations & Notes
  • Rupak Dhoot
    Ophthalmology, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Katherine Stebbins
    The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Telavive Taye
    The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Caroline Anding
    The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Arjun Jogimahanti
    The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Kimberly Mankiewicz
    The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Alice Z Chuang
    Ophthalmology, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Amir Mohsenin
    Ophthalmology, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
    Mann Eye Institute, Houston, Texas, United States
  • Footnotes
    Commercial Relationships   Rupak Dhoot, None; Katherine Stebbins, None; Telavive Taye, None; Caroline Anding, None; Arjun Jogimahanti, None; Kimberly Mankiewicz, None; Alice Chuang, None; Amir Mohsenin, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1729. doi:
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      Rupak Dhoot, Katherine Stebbins, Telavive Taye, Caroline Anding, Arjun Jogimahanti, Kimberly Mankiewicz, Alice Z Chuang, Amir Mohsenin; Emergency Department Utilization of Ophthalmology Services. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1729.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Yearly rising emergency department (ED) visits, especially for nonemergent conditions, create significant strain on hospital systems. This study aims to determine the percentage of nonemergent ophthalmology ED consults at a Level 1 trauma center and identify associated risk factors.

Methods : All ED encounters at Memorial Hermann Hospital (Houston, TX) from 1/2015-1/2020 with ophthalmology consultation were reviewed to determine the principal ophthalmic ICD10 diagnosis code. Ophthalmic ICD10 codes were categorized as emergent, nonemergent, or unspecified based on whether it represented an immediate threat to vision or could be managed outpatient. Procedures performed, patient demographics including home zip code, and insurance type were recorded. The zip code was used to calculate distance to the hospital and obtain published median income data for that area. Risk factors that affect the incidence of nonemergent visits were identified using stepwise logistic regression analysis.

Results : There were 6789 encounters of which 5075(75%) were emergent, 1275(19%) were nonemergent, and 437(6%) were unspecified. The mean age was 41.6 years (±21.2) and 3942(58%) were males. The most frequent diagnosis was a fracture related diagnosis such as orbital floor or medial wall fracture 1170(17%), followed by eyelid laceration 507(7%) and corneal abrasion 373(5%). 1293 procedures were performed with the most frequent procedures being repair of open globe 284(22%), margin laceration 232(18%), and simple eyelid laceration 205(16%). Risk factors for nonemergent encounters were: females (Odds ratio (OR)=1.9 vs males, P<0.001), seniors 65+ (OR=1.5 vs adult 18–34 years, P<0.001), median income >100k (OR=1.4 compared to $40–$60k, P=0.021), patients who live <10 miles from the hospital (OR=1.5 vs >30 miles, P<0.001) and patients who had commercial insurance (OR=1.6 vs self pay, P<0.001).

Conclusions : Most encounters resulted in an emergent diagnosis underscoring the importance of ophthalmic emergency triage. The most frequent diagnosis (fracture) however did not correspond to most frequently performed ophthalmic interventions illustrating that a large portion of ED ophthalmic care does not result in surgical intervention. This data and the demonstrated risk factors for non-emergent use may help identify areas for intervention to optimize ED efficiency.

This is a 2021 ARVO Annual Meeting abstract.

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