大型学术转诊中心的神经眼科急诊和住院会诊。
Neuro-ophthalmology Emergency Department and Inpatient Consultations at a Large Academic Referral Center.
机构信息
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.
出版信息
Ophthalmology. 2023 Dec;130(12):1304-1312. doi: 10.1016/j.ophtha.2023.07.028. Epub 2023 Aug 5.
PURPOSE
Prompt neuro-ophthalmology consultation prevents diagnostic errors and improves patient outcomes. The scarcity of neuro-ophthalmologists means that the increasing outpatient demand cannot be met, prompting many emergency department (ED) referrals by non-neuro-ophthalmologists. We describe our quaternary care institution's ED and inpatient neuro-ophthalmology consultation patterns and patient outcomes.
DESIGN
Prospective observational study.
PARTICIPANTS
Consecutive neuro-ophthalmology ED and inpatient consultation requests over 1 year.
METHODS
We collected patient demographics, distance traveled, insurance status, referring provider details, consultation question, final diagnosis, complexity of consultation, time of consultation, and need for outpatient follow-up.
MAIN OUTCOME MEASURES
Consultation patterns and diagnoses, complexity, and follow-up.
RESULTS
Of 494 consecutive adult ED and inpatient neuro-ophthalmology consultations requested over 1 year, 241 of 494 consultations (49%) occurred at night or during weekends. Of ED consultations (322 of 494 [65%]), 127 of 322 consultations (39%) occurred during weekdays, 126 of 322 consultations (39%) occurred on weeknights, and 69 of 322 consultations (22%) occurred on weekends or holidays. Of 322 ED consultations, 225 of 322 consultations (70%) were patients who initially sought treatment in the ED with a neuro-ophthalmic chief symptom. Of the 196 patients sent to the ED by a health care professional, 148 patients (148/196 [76%]) were referred by eye care specialists (74 optometrists and 74 ophthalmologists). The most common ED referral questions were for papilledema (75 of 322 [23%]) and vision loss (72 of 322 [22%]). A total of 219 of 322 patients (68%) received a final active neuro-ophthalmic diagnosis, 222 of 322 patients (69%) were cases of high or very high complexity, and 143 of 322 patients (44%) required admission. Inpatient consultations (n = 172) were requested most frequently by hospitalists, including neurologists (71 of 172 [41%]) and oncologists (20 of 172 [12%]) for vision loss (43 of 172 [25%]) and eye movement disorders (36 of 172 [21%]) and by neurosurgeons (58 of 172 [33%]) for examination for mass or a preoperative evaluation (19 of 172 [11%]). An active neuro-ophthalmic diagnosis was confirmed in 67% of patients (116 of 172). Outpatient neuro-ophthalmology follow-up was required for 291 of 494 patients (59%).
CONCLUSIONS
Neuro-ophthalmology consultations are critical to the diagnosis and management in the hospital setting. In the face of a critical shortage of neuro-ophthalmologists, this study highlights the need for technological and diagnostic aids for greater outpatient access.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的
及时的神经眼科会诊可避免诊断错误并改善患者的预后。神经眼科医生的短缺意味着日益增长的门诊需求无法得到满足，这促使许多非神经眼科医生将患者转至急诊部（ED）。我们描述了我们的四级医疗机构的 ED 和住院神经眼科会诊模式和患者结局。
设计
前瞻性观察性研究。
参与者
在一年时间内连续进行的神经眼科 ED 和住院会诊请求。
方法
我们收集了患者的人口统计学信息、就诊距离、保险状况、转诊医生的详细信息、会诊问题、最终诊断、会诊的复杂性、会诊时间以及是否需要门诊随访。
主要观察指标
会诊模式和诊断、复杂性和随访。
结果
在一年时间内连续进行的 494 例成人 ED 和住院神经眼科会诊中，有 241 例（49%）是在夜间或周末进行的。在 ED 会诊（322 例中的 127 例[39%]）中，127 例发生在工作日，322 例中的 126 例发生在周中晚上，322 例中的 69 例发生在周末或节假日。在 322 例 ED 会诊中，有 225 例（322 例中的 225 例[70%]）是最初在 ED 以神经眼科主要症状就诊的患者。在由医疗保健专业人员转至 ED 的 196 例患者中，有 148 例（196 例中的 148 例[76%]）是由眼科专家（74 名验光师和 74 名眼科医生）转诊的。ED 最常见的会诊问题是视乳头水肿（322 例中的 75 例[23%]）和视力丧失（322 例中的 72 例[22%]）。共有 219 例（68%）患者最终被诊断为活跃的神经眼科疾病，322 例患者中有 222 例（69%）为高或极高复杂程度的病例，143 例（44%）需要住院治疗。住院会诊（n=172）最常由医院医生请求，包括神经科医生（172 例中的 71 例[41%]）和肿瘤科医生（172 例中的 20 例[12%]），用于治疗视力丧失（172 例中的 43 例[25%]）和眼球运动障碍（172 例中的 36 例[21%]），神经外科医生（172 例中的 58 例[33%]）用于检查肿块或进行术前评估（172 例中的 19 例[11%]）。在 172 例患者中，有 67%（116 例）的患者被确诊为活跃的神经眼科疾病。在 494 例患者中，有 291 例（59%）需要进行神经眼科的门诊随访。
结论
神经眼科会诊对医院环境中的诊断和治疗至关重要。在神经眼科医生严重短缺的情况下，本研究强调需要技术和诊断辅助手段来增加对门诊的访问。
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