A Descriptive Analysis of Ophthalmology Emergency Call Coverage at a Major University Health Center in Canada

Authors: Jonathan El-Khoury, Bryan Arthurs, Christian El-Hadad.  

Author Disclosures: J. El-Khoury:  None.  B. Arthurs:  None.  C. El-Hadad:  None=

Abstract Body:  

Purpose: To measure annual population-based volume of ophthalmology on-call coverage at major university health centers in Canada.  

Study Design:  Descriptive study  

Methods:  Files from 9401 patients referred to McGill University-affiliated ophthalmology services between 2015 and 2021 were reviewed. Patients were referred to one of four teaching hospitals in the city of Montreal, encompassing a variety of health centers, including a hospital that mainly manages general ophthalmology cases, a pediatric hospital, a tertiary trauma center, and a hospital that provides subspecialized eye care. Data collected included age, sex, date and year, hospital, diagnosis, and type of clinician who saw the patient (ophthalmology attending, fellow, resident, other). Diagnoses were classified into 18 different categories based on the Canadian version of the International Classification of Diseases, version 10 (v.2009 and v.2012. ICD-10-CA).  

Results:  6689 referrals were analyzed after excluding cases that were not seen by ophthalmology and cases before 2016 or after 2019. On average, the combined clinical load during after-hours and on weekends was 4.6 referrals per 24-hour period. The most common diagnosis was trauma (N=1815, 26.6%), followed by keratitis (N=924, 13.5%), retinal disorders (N=883, 12.9%), and vitreous disorders (N=669, 9.8%). Trauma cases occurred more frequently in men (65.0%, compared to 52.6% male when combining all diagnoses). The most common diagnosis categories after trauma were posterior segment pathologies (23.3%), followed by anterior segment disease (22.3%), orbital and adnexal problems (9.5%), uveitis (5.8%), neuro-ophthalmic disorders (4.6%), and glaucoma (4.6%). A decreasing trend in the number of referrals was noted, where more patients were seen in the first half of the academic year (July - December) than in the second half. Moreover, an increasing proportion of total cases were managed over the phone and referred to outpatient clinic rather than seen in the emergency clinic outside of working hours in the first half of the academic year compared to the second. 91.6% (N=6130) of patients were seen by a resident.  

Conclusions:  This study aids in qualifying and quantifying the patterns of urgent referrals to ophthalmology departments in a tertiary care center. Furthermore, it can be valuable in preparation for the competency by design curriculum which may be implemented by the Royal College of Physicians and Surgeons of Canada for residency programs in the coming years.