Minor eye problems overburdening emergency departments
Thursday, March 16, 2017
Despite limited resources, emergency departments (EDs) face ever-increasing demand to provide effective clinical care. The National Hospital Ambulatory Medical Care Survey reported that in 2002, only 56.5 percent of all visits to the ED were emergent or urgent.
In the United States, approximately 136.3 million visits are made to EDs each year. In 2011, there were about 421 visits to the ED for every 1,000 individuals in the population, with more than five times as many individuals discharged (359 per 1,000 population) as were admitted to the same hospital (62 per 1,000 population).
Many of these visits were for eye-related problems.
Overburdening EDs with minor eye problems is a growing issue. From 2006 to 2011, a study reported 11,929,955 ED visits for eye problems across the U.S., and these visits were categorized as emergent (41.2 percent), nonemergent (44.3 percent) or could not determine (14.5 percent).
The study concluded that interventions to facilitate management of these cases outside the ED could make ED resources more available for eye problems and medical issues that were truly emergencies.
In a new study at the University of Michigan School of Ophthalmology, researchers reported that 1 in 4 people who visit the ED for eye problems have mild conditions, such as conjunctivitis, belpharitis and chalazion that could be otherwise treated.
A total of 377,000 eye-related ED visits by people with individual insurance were evaluated over 14 years. Of the 11,160,833 individuals eligible for this study, 376,680 (3.4 percent) had one or more ED visit for an eye-related problem. Among those enrolled, 86,473 (23 percent) had one or more ED visits with a nonemergent ocular condition and 25,289 (6.7 percent) had at least one ED visit with an urgent ocular condition.
Those who used the ED for nonurgent ocular problems were generally younger, lower-income males of black race or Latino ethnicity. It was noted that those who were in the care of an optometrist or ophthalmologist on a regular basis were less likely to seek emergency care for minor eye problems.
Other factors that may increase ED visits for nonemergent eye problems may include the lack of eye specialists in low-income areas as well as the inability of younger patients to visit their ophthalmologists during work hours, forcing them to seek care at night and weekends.
EDs in the U.S. provide a large amount of eye care that is not necessarily trauma related. Among other potential solutions, ED visits for nonemergent eye-related problems may be more appropriately managed at facilities outside the ED, which would spare ED resources for truly emergent conditions.
Study author Brian Stagg, ophthalmologist, lead author and clinical scholar at the University of Michigan, suggests that health insurers, healthcare professionals and EDs work together to help people get the eye care they need in the right setting. To avoid inappropriate ED use, Stagg suggests telemedicine appointments, incentives to healthcare providers to encourage after-hour appointments and insurance coverage that includes regular eye examinations for those who wear contacts or eyeglasses.
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