RETROSPECTIVE ANALYSIS OF OPHTHALMIC REFERRALS FROM COMMUNITY HOSPITAL EMERGENCY DEPARTMENTS

Telemedicine has shown merit in improving emergency department (ED) triage accuracy of ocular complaints. This study aims to characterize referrals from the ED to ophthalmology at a community practice in Kitchener-Waterloo, Canada in order to identify areas of ophthalmic care that may be enhanced with the addition of a teleophthalmology platform.

This retrospective case series included patients referred from an ED to an on-call ophthalmology service at the Ocular Health Centre in Kitchener, Ontario between January 2021 and July 2021. Patients who did not attend the consultation appointment were excluded. 

The primary outcome was percent agreement between the referring physician and the ophthalmology service on exact diagnosis and on classification of ocular pathology. Secondary outcomes included average patient wait times in the ED, number of CT imaging tests done, and number of appropriate CTs based on the ophthalmologist’s diagnosis. Logistic regression was done to identify factors that contributed to diagnostic agreement.

196 patients (mean age: 46.6, 51.5% female) were included. Exact diagnostic agreement was 46.9% and agreement based on classification was 61.2%. Mean [standard deviation] ED wait time was 3.2 [2.2] hours. 24 CTs were done, of which 10 were deemed appropriate based on final diagnosis. 3 patients received a final diagnosis that would warrant a CT but did not receive one in the ED (Cohen’s kappa [95% confidence interval] = 0.50 [0.29, 0.70], p<0.001). Multivariate logistic regression found that ocular surface pathology (p<0.01), posterior segment pathology (p<0.05), and increased time between referral and consultation (p<0.05) were associated with increased agreement based on classification.

Diagnostic agreement is moderate between emergency physicians and on-call ophthalmologists, and improved when the diagnosis involved the ocular surface or posterior segment. Future studies should assess whether a teleophthalmology service improves wait times and diagnostic agreement for patients presenting to the ED with urgent ocular complaints.