Schwartz Nicholas U, Silverman Andrew, Beres Shannon, Moss Heather E, Kvam Kathryn, Galetta Kristin
Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
Neurohospitalist. 2025 Jan 29:19418744251317260. doi: 10.1177/19418744251317260.
Nonmydriatic ocular fundus photography has been studied with demonstrated benefit in the evaluation of emergency department neurological complaints, particularly in triaging headache and focal neurological deficits. Likewise, portable fundus camera usage may be practical for inpatients with neurological complaints, although feasibility has not been studied in a neurology teaching service. The objective of this study is to determine if a portable, nonmydriatic fundus camera could be integrated into routine clinical care by neurology inpatient housestaff at a tertiary medical center. Housestaff were asked to obtain fundus photographs for patients with specific indications for fundoscopy. During a 1-month pilot period, housestaff were successfully able to upload images from 21 patients, which were reviewed by a neuro-ophthalmology attending, with input from on-call ophthalmology if desired. Surveys of housestaff before (n = 13) and after (n = 12) implementation demonstrated increased confidence in camera operation and in ocular structure identification, description, and interpretation. Thematic analysis on qualitative feedback suggested benefits in clinical (improving fundus visualization, aiding in triage, sharing images with offsite staff), health systems (reducing length of stay, reducing ophthalmology consultations, reduced unnecessary testing), and educational domains (facilitating group discussions of images, sharing photographs with patients). Overall, inpatient portable fundus photography was shown to be feasible and effective for rapid fundus visualization for neurological inpatients, enhancing the ability to share, document, and compare examinations among neurology housestaff. Further work is needed to confirm clinical and educational benefits of portable fundus photography usage by neurology residents, as suggested by this healthcare quality improvement pilot study.
非散瞳眼底摄影已被研究，在急诊科神经科疾病评估中显示出益处，特别是在对头痛和局灶性神经功能缺损进行分诊时。同样，便携式眼底相机的使用对于有神经科疾病的住院患者可能是可行的，尽管其在神经科教学服务中的可行性尚未得到研究。本研究的目的是确定便携式非散瞳眼底相机能否被三级医疗中心的神经科住院医师纳入常规临床护理。要求住院医师为有眼底镜检查特定指征的患者拍摄眼底照片。在为期1个月的试点期间，住院医师成功上传了21例患者的图像，这些图像由神经眼科主治医师进行了审查，并在需要时听取了值班眼科医生的意见。对实施前（n = 13）和实施后（n = 12）的住院医师进行的调查显示，他们在相机操作以及眼部结构识别、描述和解读方面的信心有所增强。对定性反馈的主题分析表明，在临床（改善眼底可视化、辅助分诊、与院外工作人员共享图像）、卫生系统（缩短住院时间、减少眼科会诊、减少不必要的检查）和教育领域（促进对图像的小组讨论、与患者共享照片）方面都有好处。总体而言，住院患者便携式眼底摄影被证明对于神经科住院患者快速进行眼底可视化是可行且有效的，增强了神经科住院医师之间共享、记录和比较检查结果的能力。正如这项医疗质量改进试点研究所表明的，需要进一步开展工作来确认神经科住院医师使用便携式眼底摄影的临床和教育益处。
