JUN 25, 2021
Investigators assessed the safety of an on-call system serviced by junior residents that triaged patients who presented with symptoms concerning for posterior vitreous detachment (PVD), retinal tear or retinal detachment.
This prospective study tracked 228 patients who presented with flashes, floaters or a curtain in vision and were seen by an on-call junior resident at a single institution during 2017. Analysis of baseline characteristics on initial and follow-up examinations helped determine the safety of having junior residents triage patients with these symptoms.
Approximately 34% of all encounters had a perceived retinal tear or detachment. There were 10 false-positive tears or detachments, and 13 false-negative tears; there were no false-negative detachments.
Residents used B-scan ultrasonography as an adjunct to examination in 41% of cases. In-person confirmation of exam findings by a senior resident or fellow occurred in 24% of encounters. Of 151 patients who showed no pathologic features on initial exam, 52 had shorter follow-up times to a retina clinic rather than a nonretinal clinic.
Twenty-nine patients did not follow-up at the same institution, possibly due to preference of being seen closer to home or resolution of symptoms. This resulted in a follow-up rate of 88.7% which could have affected the final false-positive and false-negative rates. Rather than indicating that the resident missed the finding, it is possible that the false-negative tears may actually represent delayed onset of tears. The varying skill levels of residents between institutions can affect the generalizability of these results.
This study demonstrates that junior residents can safely provide on-call triage of patients with symptoms concerning for a PVD, retinal tear, or retinal detachment. However, the safe use of junior residents as initial triage does require moderate resource allocation. It can include a high rate of ultrasonography, occasional confirmatory examinations by a second physician and shorter follow-up times with a retina physician for high-risk patients.