Can telehealth tools in emergency rooms improve access and outcomes for on-call eye triage? April Y. Maa, MD, outlined the challenges and opportunities during Saturday’s symposium “Using Technology to Solve the Biggest Problems in Ophthalmology” (Sym04).
“No doctor wants to go into the ER to see a patient who doesn’t need to be seen right away,” said Dr. Maa. Yet this happens all too often today.
Eye care in the ER is problematic. More than 2 million people go to the ER and/or urgent care each year for acute eye complaints, yet ERs often have difficulty finding ophthalmology coverage. What’s more, ER physicians often lack necessary equipment and skills to make appropriate diagnoses. This leads to greater morbidity, increased wait times, and unnecessary costs due to erroneous transfers.
Telehealth tools can help save money and improve outcomes. Studies show a range from $500,000+ to $3.2 million in cost savings if patients can be seen in the eye clinic rather than the ER. Telehealth can also help to identify emergent cases easily and accurately as well as to reduce wait times and unnecessary referrals.
The challenge of making accurate diagnoses. Three of the top four eye diagnoses in the ER are anterior segment diseases (conjunctivitis, corneal abrasion/foreign body, and iritis/uveitis), which are usually identified with a slit lamp, said Dr. Maa. But because of their steep cost and learning curve, slit lamps aren’t ideal for ERs. At the same time, external photos don’t provide sufficient sensitivity, she said.
Telehealth carts hold promise. Telehealth carts—commonly found in ERs—have options for peripheral plug-ins for fundus photo and even slit-lamp imaging equipment, said Dr. Maa. These smaller-footprint machines may be easier to use and offer a strong option for anterior segment exams, she said. Studies suggest that synchronous care—with a direct audio and video connection between the ophthalmologist and the ER staff—is best and most accurate.
Current data on fundus and slit-lamp imaging peripherals. A study at Emory evaluating the use of nonmydriatic fundus photos in the ER found that they substantially improved triage in the waiting room, said Dr. Maa. The camera was easy to use, images took less than five minutes to obtain, and they could be interpreted by an ophthalmologist asynchronously. However, in another trial currently underway through the VA and Emory, interim data suggest that using a slit-lamp video peripheral via a telehealth cart doesn’t necessarily help diagnostic accuracy for the anterior segment. —Reena Mukamal
Financial disclosures: Dr. Maa: Click Therapeutics: C; Warby Parker: C.
Disclosure key: C = Consultant/Advisor; E = Employee; EE = Employee, executive role; EO = Owner of company; I = Independent contractor; L = Lecture fees/Speakers bureau; P = Patents/Royalty; PS = Equity/Stock holder, private corporation; S = Grant support; SO = Stock options, public or private corporation; US = Equity/Stock holder, public corporation. For definitions of each category, see aao.org/eyenet/disclosures.
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