Abstract
Purpose :
A multicenter quality improvement project focused on improving patient care by enhancing the quality of ophthalmology consults placed by both emergency department and inpatient primary providers. Carter and Miller showed that ophthalmology consult service influences overall patient management plans in 56.5% of consults. We hypothesize that education of residents and physician assistants who serve as the majority of primary care providers placing Ophthalmology consults at two teaching hospitals in Brooklyn and Queens, New York will result in better quality of ocular consults placed and thus significantly improve ophthalmology residents’ ability to appropriately triage and treat patients in a timely fashion.
Methods :
Primary providers at each hospital were given a one-hour lecture and a summary handout on measurement of ocular vital signs (visual acuity, pupillary response, and extraocular movements) and common ophthalmic conditions such as corneal abrasion, conjunctivitis, corneal foreign body, orbital wall fractures, and chemical burns. The quality of ophthalmology consultations in the three months before and after the lectures were quantified by the on-call ophthalmology residents receiving the consultation call, who assigned one point to each ocular vital sign obtained prior to and provided by the primary provider during the consultation. Statistical analysis using two tailed sample T testing was then undertaken to determine frequency of well-informed consults pre- and post-lecture.
Results :
Visual acuity was 50% more likely of the three vital signs to be provided, and pupillary response and extraocular movements were often omitted from consultation calls pre-lecture. However, a doubling of the frequency with which each of the three vital signs was provided post-lecture was noted. Improved quality of the consultation calls was qualitatively associated with enhanced resident triage ability.
Conclusions :
This one-year pilot quality improvement project demonstrated a strong correlation between enhanced quality of consults placed by primary providers and improved patient triage and clinical care. A second phase of this project expanding upon the pilot study is currently underway.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.