Research Institute of the McGill University Health Centre, Montreal, QC.
Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QC.
Can J Ophthalmol. 2024 Apr;59(2):e111-e116. doi: 10.1016/j.jcjo.2023.01.004. Epub 2023 Jan 23.
This study aims to characterize the epidemiology, common reasons, and diagnostic accuracy of referrals made by emergency departments (EDs) and optometrists to an emergency ophthalmology consultation service as well as to identify opportunities for improvement.
Retrospective chart review.
A total of 1249 referrals made to the emergency ophthalmology consultation service at a tertiary care centre between July 2018 and June 2019.
Patient charts were examined, and clinical variables were extracted. Statistical significance (p < 0.05) was determined via t tests and χ tests for continuous and categorical variables, respectively. Diagnostic accuracy of providers and time delay between referral and ophthalmologic encounter also were assessed.
Both EDs and optometrists most often referred cases with vitreoretinal (36.48% and 37.19%, respectively) and corneal pathology (21.42% and 20.25%, respectively). Optometrists (n = 240; 52.48%) were significantly more accurate in their diagnoses than EDs (n = 940; 32.45%; p < 0.00001). Specifically, optometrists were significantly more accurate when diagnosing anterior-chamber (n = 29; 58.62%; p = 0.039) and vitreoretinal (n = 89; 60.67%; p < 0.00001) pathology than EDs (anterior chamber, n = 77, 36.36%; vitreoretinal, n = 344, 18.90%). Across all ED referrals (n = 940), 58 (6.17%) had a prolonged delay. Across all optometrist-to-ED referrals (n = 150), 6 (4.00%) had a prolonged delay. Accounting for all cases, the total incidence of prolonged delay was 5.87%.
Our results demonstrate the need for improved communication between optometrists and ophthalmologists to reduce the wait-time burden on EDs. Patients may benefit from direct referral by optometrists to ophthalmologists. Education of allied health professionals on ophthalmic disease also may improve diagnostic accuracy.
本研究旨在描述急诊科（ED）和验光师向急诊眼科会诊服务转诊的流行病学、常见原因和诊断准确性，并确定改进的机会。
回顾性图表审查。
2018 年 7 月至 2019 年 6 月期间，三级护理中心的急诊眼科会诊服务共收到 1249 份转诊。
检查患者病历并提取临床变量。通过 t 检验和 χ 检验分别确定连续和分类变量的统计学意义（p<0.05）。还评估了提供者的诊断准确性和转诊与眼科就诊之间的时间延迟。
ED 和验光师最常转诊的是玻璃体视网膜（分别为 36.48%和 37.19%）和角膜病变（分别为 21.42%和 20.25%）。与 ED（n=940；32.45%；p<0.00001）相比，验光师（n=240；52.48%）的诊断准确率显著更高。具体来说，验光师在诊断前房（n=29；58.62%；p=0.039）和玻璃体视网膜（n=89；60.67%；p<0.00001）病变方面明显优于 ED（前房，n=77，36.36%；玻璃体视网膜，n=344，18.90%）。在所有 ED 转诊（n=940）中，有 58 例（6.17%）存在延迟。在所有验光师至 ED 转诊（n=150）中，有 6 例（4.00%）存在延迟。在所有病例中，总延迟发生率为 5.87%。
我们的结果表明，需要改善验光师和眼科医生之间的沟通，以减少 ED 的等待时间负担。患者可能受益于验光师直接向眼科医生转诊。对辅助卫生专业人员进行眼科疾病教育也可能提高诊断准确性。
