ORIGINAL ARTICLE

Reliability of ophthalmic accident and emergency referrals: a new role for the emergency nurse practitioner?

D G Ezra, F Mellington, H Cugnoni, M Westcott

Departments of Ophthalmology and Accident & Emergency Medicine, St Bartholomew’s and the Royal London NHS Trust, London, UK

Correspondence to:
Correspondence to:
D G Ezra
daniel_ezra{at}hotmail.com

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.

Abbreviations: A&E, accident and emergency; ENP, emergency nurse practitioner; SHO, senior house officer

Keywords: A&E; ENP; nurse practitioner; ophthalmology; referral

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This article has been cited by other articles:

• Hau, S, Ioannidis, A, Masaoutis, P, Verma, S (2008). Patterns of ophthalmological complaints presenting to a dedicated ophthalmic Accident & Emergency department: inappropriate use and patients' perspective. Emerg. Med. J. 25: 740-744 [Abstract] [Full Text]  
• Whiticar, R, Webb, H, Smith, S (2008). Re-attendance to the emergency department. Emerg. Med. J. 25: 360-361 [Abstract] [Full Text]  
• Sim, D, Hussain, A, Tebbal, A, Daly, S, Pringle, E, Ionides, A (2008). National survey of the management of eye emergencies in the accident and emergency departments by senior house officers: 10 years on--has anything changed?. Emerg. Med. J. 25: 76-77 [Abstract] [Full Text]  
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