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The role of video conferencing technology in emergency ophthalmology services during the Covid-19 pandemic
First Author: R. Yardy UK
Co Author(s): A. Fonseca V. Golash S. Athwal M. Khandwala
The COVID-19 crisis required the development of teleophthalmology services to provide safe and effective eye care out-of-hours. Video consultations allow the on-call registrar to assess the patient further than telephone consultation alone. Thereby providing specialist advice whilst minimising frequency and duration of face-to-face contact for patients and health-workers alike. Such services are being piloted and used across other specialties and hospitals in the country. The aim of this project is to ascertain the role this technology can play in providing a safe and effective acute ophthalmology service out-of-hours within the existing framework.
Ophthalmology patients seen out-of-hours in the Maidstone Hospital Accident and Emergency, Maidstone and Tunbridge Wells NHS Trust.
Initially an Emergency Nurse Practitioner (ENP), without ophthalmic experience, examined the patient in A&E whilst linked to the ophthalmology registrar via video consultation on AttendAnywhereﾮ. A management plan was agreed upon and the safety of this checked by a trained senior ENP, with ophthalmology experience. Any discrepancy in the plans was discussed immediately (before the patient left the department) and further review by the ophthalmology team was arranged as necessary, including face-to-face review in A&E.
Pilot data included 15 patients seen by A&E and the on-call ophthalmologist via video consultation. The data demonstrated video-consultation is a safe additional tool for assessing patients in a casualty setting. There was 100% agreement between the ophthalmology registrarsﾒ clinical plan via video-consultation and the safety review conducted by the experienced ENP. Limitations included hospital internet services affecting image resolution, issues with the cameraﾒs auto-focus function, and the untrained ENPﾒs lack of familiarity with slit-lamp functions.
Video consultation is a safe and useful additional tool in the assessment of ophthalmology patients in A&E during an on-call. It can be used to aide diagnosis of anterior segment cases whilst minimising frequency and duration of contact for patients and health-workers. Future applications may include providing opinions cross-site, to community services, or to centres in more remote locations without having to transfer patients. It would also be useful to investigate the role of video consultation facilitating consultant on-call review for patients seen by the first on-call registrar.
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