Wilmer General Eye Services, The Johns Hopkins Hospital, Baltimore, Maryland.
Wilmer Eye Institute, Baltimore, Maryland.
JAMA Ophthalmol. 2019 Jul 1;137(7):729-735. doi: 10.1001/jamaophthalmol.2019.0864.
Convenient outpatient access for ophthalmology patients seeking urgent care could offer savings compared with an emergency department (ED) visit.
To evaluate the costs and visit durations of same-day access (SDA) in an ophthalmology department at an academic medical center vs ED care.
DESIGN, SETTING, AND PARTICIPANTS: This single-center study was a retrospective quality improvement analysis of an institutional electronic medical record system at the Wilmer Eye Institute clinics and the Johns Hopkins Hospital ED. On June 1, 2015, the Wilmer Eye Institute and Johns Hopkins Hospital initiated an official policy of providing SDA to patients calling for appointments (ie, the same-day project). All ophthalmology clinic locations created same-day appointment slots for at least 1 practitioner. In recognition of seasonal variations in patient visit volumes, the 10 months before implementation (August 1, 2014, to May 31, 2015) were compared with complementary periods in 2015 to 2016 and 2016 to 2017.
The study tabulated encounters, charges, and visit length for outpatients seen on the same day or by previously scheduled appointments. For the ED patients, volume, diagnoses, charges, and length of stay data were collected. The numbers of SDA patients who indicated urgency were tabulated.
The number of SDA patients increased from 22 781 to 26 579 for the first year after SDA implementation. The mean charge was $258 (95% CI, $250-$266; median, $184; interquartile range [IQR], $175-$320), and the mean clinic transit time was 1.55 hours (95% CI, 1.54-1.57 hours; median, 1.28 hours). For patients seeking eye care in the ED, the mean professional fee was $401 (95% CI, $390-$411; median, $360; IQR, $255-$500), the mean (SD) total hospital charge was $1040 ($999) (95% CI, $729-$1079; median, $1002; IQR, $334-$1429), and the mean length of stay was 7.30 hours (95% CI, 7.01-7.57 hours; median, 7.20 hours). The top 4 ophthalmic diagnoses for ED patients were conjunctivitis, cornea abrasion, iritis, and visual loss, which were unchanged after SDA implementation. In calendar year 2017, a total of 4062 SDA patients reported urgency; their estimated savings in charges compared with an ED visit were $580 866 in professional fees and $3 176 484 in hospital charges.
Same-day access appears to be less expensive and to require less time in the health care system than a visit to the ED for an ophthalmic diagnosis. Substantial savings in time and money might be achieved if urgent eye care is delivered in the clinic rather than the ED.
对于寻求紧急护理的眼科患者来说，方便的门诊就诊可能比急诊就诊更节省费用。
评估在学术医学中心的眼科部门进行当天就诊（SDA）的成本和就诊时间与急诊护理相比。
设计、地点和参与者：这是一项单中心研究，是对威尔默眼科研究所诊所和约翰霍普金斯医院急诊室机构电子病历系统的回顾性质量改进分析。2015 年 6 月 1 日，威尔默眼科研究所和约翰霍普金斯医院开始为预约就诊的患者提供 SDA 的正式政策（即当日项目）。所有眼科诊所都为至少 1 名医生开设了当天预约的预约时段。为了认识到患者就诊量的季节性变化，在实施前的 10 个月（2014 年 8 月 1 日至 2015 年 5 月 31 日）与 2015 年至 2016 年和 2016 年至 2017 年的同期进行了比较。
本研究列出了当天就诊或按先前预约就诊的门诊患者的就诊、费用和就诊时间。对于 ED 患者，收集了就诊量、诊断、费用和住院时间数据。列出了表示紧急情况的 SDA 患者人数。
在 SDA 实施后的第一年，SDA 患者的数量从 22781 人增加到 26579 人。平均费用为 258 美元（95%CI，250-266 美元；中位数，184 美元；四分位距 [IQR]，175-320 美元），平均就诊时间为 1.55 小时（95%CI，1.54-1.57 小时；中位数，1.28 小时）。对于在 ED 寻求眼部护理的患者，专业费用平均为 401 美元（95%CI，390-411 美元；中位数，360 美元；IQR，255-500 美元），总医院费用平均为 1040 美元（999 美元）（95%CI，729-1079 美元；中位数，1002 美元；IQR，334-1429 美元），平均住院时间为 7.30 小时（95%CI，7.01-7.57 小时；中位数，7.20 小时）。ED 患者的前 4 种眼科诊断为结膜炎、角膜擦伤、虹膜炎和视力丧失，在 SDA 实施后没有变化。在 2017 年的日历年中，共有 4062 名 SDA 患者报告了紧急情况；与 ED 就诊相比，他们的费用估计节省了 580866 美元的专业费用和 3176484 美元的医院费用。
当天就诊似乎比 ED 就诊更便宜，也更节省眼科诊断的就诊时间。如果在诊所而不是 ED 提供紧急眼部护理，可能会节省大量的时间和金钱。
