Prompt neuro-ophthalmology consultation prevents diagnostic errors and improves patient outcomes. The scarcity of neuro-ophthalmologists cannot meet the increasing outpatient demand, prompting many emergency department (ED) referrals by non-neuro-ophthalmologists. We describe our quaternary care institution’s ED and inpatient neuro-ophthalmology consultation patterns and patient outcomes.
Prospective observational study.
Consecutive neuro-ophthalmology ED and inpatient consultation requests over one year.
We collected patient demographics, distance traveled, insurance status, referring provider details, consultation question, final diagnosis, complexity of consultation, time of consultation, and need for outpatient follow-up.
Consultation patterns and diagnoses, complexity and follow-up.
Of 494 consecutive adult ED and inpatient neuro-ophthalmology consultations requested over 1 year (average age 48±18 years, 64% women), 241/494 (49%) occurred at night or during weekends. Of ED consultations (322/494; 65%), 127/322 (39%) occurred during weekdays, 126/322 (39%) on weeknights, and 69/322 (22%) on weekends/holidays. Of 322 ED consultations, 225/322 (70%) presented to the ED with a neuro-ophthalmic chief complaint. Of the 196 patients sent to the ED by a health care professional, 148 (148/196, 76%) were referred by eye care specialists (74 optometrists; 74 ophthalmologists). The most common ED referral questions were for papilledema (75/322, 23%) and vision loss (72/322; 22%), 219/322 (68%) had a final active neuro-ophthalmic diagnosis, 222/322 (69%) were of high or very high complexity, and 143/322 (44%) required admission. Inpatient consultations (172) were most frequently requested by hospitalists, including neurologists (71/172, 41%), and oncologists (20/172, 12%) for vision loss (43/172, 25%) and eye movement disorders (36/172, 20%), and by neurosurgery (58/172, 33%) for examination for mass/pre-operative evaluation (19/172, 11%). An active neuro-ophthalmic diagnosis was confirmed in 67% (116/172) of patients. Neuro-ophthalmic assessment was appropriate to make a diagnosis or evaluate for ophthalmic manifestations of disease in 446/494 patients (90%). Outpatient neuro-ophthalmology follow-up was required for 291/494 patients (59%).
Neuro-ophthalmology consultations are critical to diagnosis and management in the hospital setting. In the face of a critical shortage of neuro-ophthalmologists, this study highlights the need for technological and diagnostic aids for greater outpatient access..
Copyright © 2023. Published by Elsevier Inc.
