Authors: Isabelle D. Gauthier, Shireen Hussein, Henry Liu, Ismail Abdulle, Alexander Pearson, David H. Zackon, Daniel Lelli, Rustum Karanjia
Author Disclosure Block: I.D. Gauthier: None. S. Hussein: None. H. Liu: None. I. Abdulle: None. A. Pearson: None. D.H. Zackon: None. D. Lelli: None. R. Karanjia: None.

Abstract Body:

Purpose: Subspecialty eye care clinics are responsible for providing quaternary care for patients with complex eye and often rare eye diseases. To ensure high quality patient care, it is often necessary to triage patients based on the information provided in the referral from the refereeing physician or optometrists. Neuro-ophthalmology is a subspecialty which deals with disease of the optic nerve, visual processing and efferent visual system. The purpose of this Quality Improvement Project was to better understand the current effectiveness of Neuro-ophthalmology triage process, consultation wait times, and to evaluate diagnostic discordance between the primary reason for referral and final diagnosis.

Study Design: The study was a prospective chart review.

Methods: The study included all neuro-ophthalmological consults seen in the Ottawa area over a 6 month period from February to July, 2017. As a quality improvement project, it was certified OHNS-REB exempt. The collected data included referral information such as referral source (e.g. ophthalmologist, optometrist, emergency department, primary care physician or other medical specialists), referral diagnosis, referral date and if the referral was marked as urgent. It also included the date seen at the clinic, the impression from the attending neuro-ophthalmologist and final diagnosis.

Results: Of the approximately 800 patients assessed by the three neuro-ophthalmologists in the study, almost 50% had been referred by other ophthalmologists in the region. Referrals from optometrists, external physicians and family physician accounted for about 20%, 15% and 10% respectively. The most common reason for referred was diplopia, accounting for 10% of all referrals, this was followed by unexplained vision loss and visual field defects. The average wait time between the referral and the appointment with an ophthalmologist was 75 days. About 10% of all referrals were marked urgent and the average wait times were lower at 30 days. Almost 20% of patients had a normal examination or resolved symptoms when assessed by the neuro-ophthalmologists. The final impression by neuro-ophthalmologists was in accordance with the referring diagnosis for almost 60% of the cases. There was significant diagnostic discordance in approximately a quarter of cases.

Conclusions: The results from this study will help better understand referral patterns and how it affects patient management, wait times and access to care. Appropriate and efficient consultation requests were assessed and will help address appropriate triaging of patients and potential knowledge gaps in referring professionals.