ORIGINAL ARTICLES

Patterns of ophthalmological complaints presenting to a dedicated ophthalmic Accident & Emergency department: inappropriate use and patients’ perspective

S Hau, A Ioannidis, P Masaoutis, S Verma

Accident & Emergency Department, Moorfields Eye Hospital, London, UK

Correspondence to:
Mr S Hau, Moorfields Eye Hospital, 162 City Road, London UK; scott.hau{at}moorfields.nhs.uk

Objectives: To investigate the appropriateness of patients attending an Accident & Emergency (A&E) department of an eye hospital, identify reasons for inappropriate use and propose recommendations in improving the provision of ophthalmic A&E care.

Methods: A prospective questionnaire-based survey of consecutive patients who presented to the A&E department over a 7-day period was conducted. Patient demographic data, reason for attending from the patients’ perspective, diagnosis, duration of symptom and management outcome were recorded. The diagnoses were grouped into acute and non-acute, and into those which were considered suitable to be seen in a primary care setting by specialist trained community general practitioners (GPs) or optometrists.

Results: 560 completed questionnaires were evaluated; 171 cases (30.6%) were considered as non-acute and 210 (37.5%) were considered suitable to be seen by specialist trained community GPs or optometrists. 352 patients (62.8%) had symptoms for 1–6 days, 144 (25.7%) had symptoms for 1–4 weeks and 64 (11.5%) had symptoms for >1 month before presentation; in the latter two groups, 52 of the 208 patients (25%) were diagnosed with non-acute conditions. "Great concern" was the most common reason for attending the casualty department. 350 patients (62.5%) were discharged on the day of presentation.

Conclusions: A significant number of patients who attend ophthalmic A&E departments have non-urgent conditions that could be managed satisfactorily in a primary care setting by specialist trained GPs or optometrists outside the hospital casualty department. Improvement in education of patients, the provision of specialist ophthalmic training for GPs and optometrists, and expansion of outpatient services are needed so that casualty remains a genuine emergency service.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Primary survey

Simon Carley
Emerg. Med. J. 2008 25: 709. [Extract] [Full Text] [PDF]

eLetters:

Read all eLetters

Not Cas, not A&E but Emergency Medicine

John M Ryan

EMJ Online, 19 Nov 2008 [Full text]

Re: Not Cas, not A&E but Emergency Medicine

Simon D Carley

EMJ Online, 22 May 2009 [Full text]