D G Ezra1, F Mellington, H Cugnoni, M Westcott. 1. Department of Ophthalmology, St Bartholomew's and the Royal London NHS Trust, London, UK. daniel_ezra@hotmail.com
Abstract
BACKGROUND AND OBJECTIVES: Annual attendances at the accident and emergency (A&E) department of St Bartholomew's and The Royal London NHS Trust exceed 100,000 people of which 6% are ophthalmic. This study evaluated the accuracy of eye referrals from A&E senior house officers (SHOs) and emergency nurse practitioners (ENPs) and the impact any inaccuracies may have had on out of hours work. METHODS: Over a four week period a record of all referrals from the A&E department was made. The doctor receiving the referral made a note of clinical variables as reported by the referring clinician. When the patient was subsequently reviewed by an ophthalmologist, a record was again made of these findings. Any discrepancies were recorded. RESULTS: A total of 67 patients were recruited. ENPs were found to be consistently more accurate than SHOs in every aspect of the assessment, most notably in visual acuity (p = 0.0029), and provisional diagnosis (p = 0.012). Furthermore, had the examination findings been accurate, 58% of all SHO referrals seen after hours would have been triaged to the next available clinic but only 10% of ENP referrals could have been seen at the next clinic session (p = 0.027). CONCLUSION: This study found ENPs to be more accurate than A&E SHOs in history taking, recording visual acuity, describing ocular anatomy, and making provisional diagnoses. A significant reduction in out of hours ophthalmic workload may be achieved in the authors' unit if ENPs were to see all eye emergencies.
BACKGROUND AND OBJECTIVES: Annual attendances at the accident and emergency (A&E) department of St Bartholomew's and The Royal London NHS Trust exceed 100,000 people of which 6% are ophthalmic. This study evaluated the accuracy of eye referrals from A&E senior house officers (SHOs) and emergency nurse practitioners (ENPs) and the impact any inaccuracies may have had on out of hours work. METHODS: Over a four week period a record of all referrals from the A&E department was made. The doctor receiving the referral made a note of clinical variables as reported by the referring clinician. When the patient was subsequently reviewed by an ophthalmologist, a record was again made of these findings. Any discrepancies were recorded. RESULTS: A total of 67 patients were recruited. ENPs were found to be consistently more accurate than SHOs in every aspect of the assessment, most notably in visual acuity (p = 0.0029), and provisional diagnosis (p = 0.012). Furthermore, had the examination findings been accurate, 58% of all SHO referrals seen after hours would have been triaged to the next available clinic but only 10% of ENP referrals could have been seen at the next clinic session (p = 0.027). CONCLUSION: This study found ENPs to be more accurate than A&E SHOs in history taking, recording visual acuity, describing ocular anatomy, and making provisional diagnoses. A significant reduction in out of hours ophthalmic workload may be achieved in the authors' unit if ENPs were to see all eye emergencies.
Authors: Caroline A Petrarca; Julia Warner; Andrew Simpson; Robert Petrarca; Abdel Douiri; David Byrne; Timothy L Jackson Journal: Eye (Lond) Date: 2018-05-25 Impact factor: 3.775
Authors: Nancy Wijers; Lisette Schoonhoven; Paul Giesen; Hubertus Vrijhoef; Regi van der Burgt; Joke Mintjes; Michel Wensing; Miranda Laurant Journal: BMC Fam Pract Date: 2012-08-07 Impact factor: 2.497
Authors: Rènée du Toit; Hannah B Faal; Daniel Etya'ale; Boateng Wiafe; Ingrid Mason; Ronnie Graham; Simon Bush; Wanjiku Mathenge; Paul Courtright Journal: BMC Health Serv Res Date: 2013-03-18 Impact factor: 2.655