Abstract
Objective The main objective of this article is to characterize ophthalmology consultations
in the emergency department (ED) of a tertiary care hospital and identify specific
ways to modify the curriculum for ophthalmology and emergency medicine residency programs
to train residents to effectively manage eye-related consultations.
Design This is a retrospective chart review study of ED encounters between January 1, 2008
and January 1, 2017 during which ophthalmology was consulted.
Setting Single-center urban tertiary care center.
Participants All adult patients who were seen by the ophthalmology consultation service in the
ED during the study time period.
Main Outcome Measured We identified the reason for and timing of ophthalmology consultation; diagnoses
made in the ED and follow-up ophthalmology clinic visit; procedures resulting from
consultation; and communication with a senior resident, fellow, or attending.
Results We identified 3,583 consecutive ED encounters with an ophthalmology consultation
over a 9-year period. About 51.1% of patients were female and mean age of patients
was 49 years. Blurry vision/vision loss was the most common reason for consultation
(24.8%) and posterior vitreous detachment was the most common diagnosis made in the
ED by the ophthalmology team (11.0%). Of the patients with documented follow-up ophthalmology
clinic visits, 96.7% of diagnoses made at the first ophthalmology clinic visit were
the same as those determined in the ED. About 12.7% of visits resulted in a procedure
with the most common being eyelid laceration repairs, pars plana vitrectomy, and laser
retinopexy. Overall, 40.4% of visits required communication with a senior resident,
fellow, or attending. The frequency of residents seeking assistance from more senior
ophthalmologists decreased over the course of the academic year (p < 0.0001).
Conclusions This study provides data that ophthalmology 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
medicine physicians to improve their ability to diagnose and triage ophthalmologic
presentations.
Keywords
ophthalmology consults - residency - emergency department
