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Reliability of ophthalmic accident and emergency referrals: a new role for the emergency nurse practitioner?
  1. D G Ezra,
  2. F Mellington,
  3. H Cugnoni,
  4. M Westcott
  1. Departments of Ophthalmology and Accident & Emergency Medicine, St Bartholomew’s and the Royal London NHS Trust, London, UK
  1. Correspondence to:
 D G Ezra


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.

  • A&E, accident and emergency
  • ENP, emergency nurse practitioner
  • SHO, senior house officer
  • A&E
  • ENP
  • nurse practitioner
  • ophthalmology
  • referral

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  • Competing interests: none declared