Analysis of Emergent Nonhospital-Based Retina Consultation Requests in an Academic Nonhospital-Associated Retina Practice

Abstract

To evaluate the outcomes of after-hour encounters concerning patients referred by eye physicians to on-call retina services for emergent evaluation not seen in or referred by an emergency department. Retrospective study. Patients seeking treatment at 3 private practice institutions over a 2-year period between 2017 and2018. A retrospective chart review was conducted comprising all patients who sought treatment emergently and after clinic hours from 3 academic nonhospital-associated retina-only private practice institutions over a 2-year period. Patient presenting symptoms, diagnosis given at time of after-hours appointment, duration of symptoms, source of after-hours consultation (patient or provider), procedure performed at appointment, and appointments that led to surgery. Nine hundred eighty-seven charts were reviewed. Provider referrals accounted for 49.13% (n= 485) and patient-derived referrals accounted for 50% (n= 493) of appointments. New patients accounted for 27.6% (n= 146) of patient-derived and 85.2% (n= 413) of provider-derived referrals. The most common presenting symptoms were flashes and floaters (42.5%; n= 420), decrease in visual acuity (32.1%; n= 317), generalized eye pain (7.4%; n= 73), visual field disturbance (4.3%; n= 42), and postoperative ocular pain (3.4%; n= 34). An in-office procedure was performed at the time of examination in 18% of encounters (n= 178), with most of these being laser retinopexy. Surgery was performed within 24 hours in 18% (n= 180), within 48 hours in 20.6% (n=203), within 72 hours in 21.7% (n= 214), and within 96 hours in 22.6% (n= 223) of the appointment. When combined with procedures, 36.2% (n= 358) of encounters led to urgent intervention within 24 hours. If a provider called about an existing patient, 37.5% of these appointments (n= 27) led to surgery versus 12.8% (n=49) if an existing patient self-referred. If a provider called about a new patient, 31.7% of these appointments (n= 131) led to surgery versus 10% (n= 14) if a new patient self-referred. At these 3 private practice retinal specialty clinics, 41% of after-hours appointment requests resulted in an intervention within 96 hours, and 36% of these patients underwent an intervention within 24 hours.