Abstract
Purpose :
Rising demand for rapid access emergency eye care necessitates accurate triage to optimise service utilisation. Yet, there is a dearth of literature on ophthalmic emergency triage performance in the context of the service population’s demographics and socioeconomic background. The purpose of this study was to prospectively evaluate nurse-led triage in an ophthalmic accident and emergency (A&E) service considering attendee characteristics.
Methods :
Data were collected electronically by triage nurses. Patient demographics, signs and symptoms, triage outcomes, and discharge diagnoses were recorded. The Index of Multiple Deprivation (IMD) was collected in aggregate as a surrogate measure of socioeconomic status. Discharge diagnoses were stratified as urgent or non-urgent by the consensus of 3 consultant ophthalmologists as the reference.
Results :
Consecutively, 18,693 A&E visits were collected from 1 July 2021 to 15 June 2022. The final dataset totalled 12,584(67%) visits after excluding 3,019(16%) with missing input, 1,641(9%) training entries, and 1,449(8%) paediatric or inconclusive visits.
Of these, 47.4%(5,964) were male and 52.6%(6,620) female. In aggregate, 36.9% of patients were aged 30-50, 34.5% were 50-70, 17.6% were under 30, and 11.1% were over 70. Patient ethnicities were Other(41.3%), White(23.4%), Unknown(17.2%), Asian(9.5%), Black(8.0%), and Mixed(0.6%).
Visits grouped by IMD quintiles (Q1 being most-deprived, Q5 least-deprived) ranked by proportions: Q2 (47.8%), Q3 (23.3%), Q4 (16.9%), Q1 (5.9%), Q5 (5.3%), and Unknown (0.9%). Majority(53.7%) were from Q1 and Q2.
Most visits had no red flags (89.6%). The most common diagnoses were conjunctival/corneal injury(10.6%), anterior uveitis(7.6%), dry eyes(6.4%), keratitis(6.2%), posterior vitreous detachment(5.6%), no abnormality detected(4.8%), and blepharitis(4.3%).
Overall, nurse-led triage between urgent and non-urgent cases had a sensitivity of 96.7% (95%CI 96.3-97.1%), specificity of 20.6% (19.5-21.7%), and accuracy of 63.8% (63.0-64.7%). Re-attendance rate within 2 weeks of initial presentation was 2.1%.
Conclusions :
Nurse-led triage in adult ophthalmic A&E is safe. Over-triage of non-urgent cases is common. Over 50% of all ophthalmic A&E visits were made by patients from the lowest two quintiles of deprivation. Further research into triage has the potential to improve training and empower patients at discharge.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.