Emergency Department Nonmydriatic Fundus Photography Expedites Care for Patients Referred for Papilledema.

PURPOSE

Emergency department (ED) visits to rule out papilledema or for papilledema workup are increasing. Our goal was to evaluate whether implementation of a hybrid true color nonmydriatic fundus photography and OCT camera in our ED (NMFP-OCT) combined with a "papilledema protocol" could avoid in-person ophthalmology consultations and accelerate the evaluation for papilledema.

DESIGN

Prospective quality improvement study.

PARTICIPANTS

Adult patients who underwent NMFP-OCT camera examination in our ED from June 9, 2023, through June 30, 2024, to rule out papilledema or perform a papilledema workup.

METHODS

We collected final diagnoses, ED lengths of stay, and whether an in-person ophthalmology consultation was performed in addition to remote interpretation of images. We compared ED lengths of stay with previous data prospectively collected in 2022 before installation of the NMFP-OCT camera in the ED.

MAIN OUTCOME MEASURES

Median ED length of stay in hours and number of patients in whom papilledema was ruled out remotely.

RESULTS

For patients referred to the ED for papilledema, the ED NMFP-OCT camera reduced the median ED length of stay to 12 hours (interquartile range, 7.5-26.5 hours; 337 patients) compared with 27 hours (interquartile range, 19-33 hours; 85 patients) in 2022 (P < 0.001). For the 199 patients in whom papilledema was ruled out with the NMFP-OCT camera, the ED length of stay decreased from 24.5 hours (interquartile range, 10-29 hours) in 2022 to 9 hours (interquartile range, 6.5-18.5 hours) after installation of the ED NMFP-OCT camera (P = 0.007); papilledema was ruled out remotely without in-person ophthalmology consultation in 185 of 199 patients (93%). For patients with previously known idiopathic intracranial hypertension, ED stay decreased from 24 hours in 2022 (interquartile range, 12-28 hours) to 10 hours after installation of the ED NMFP-OCT camera (interquartile range, 7.5-17 hours; 50 patients; P = 0.02).

CONCLUSIONS

Implementation of the NMFP-OCT camera in our general ED reduced the ED length of stay of patients being evaluated for papilledema by 56% and mostly avoided in-person ophthalmology consultations when papilledema was ruled out remotely on ocular imaging, reducing the burden on residents and on-call ophthalmologists.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.