Journal d'ophtalmologie clinique et expérimentale
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Referral Pattern of Nighttime Visits to the Ocular Emergency Department at a Tertiary Referral Center in Israel

Daphna Prat, Sivan Elyashiv, Ido Didi Fabian, Esther Shabtai, Hadas Newman and Michael Kinori

Objective: The structure of the Israeli healthcare system is such that it is frequently more convenient for the patient to present to an ophthalmologic emergency department (OED) at night instead of waiting for a scheduled appointment in an outpatient setting. The main objective of this study is to evaluate the diagnoses of patients who attended an OED of a tertiary referral center at night during a one-year period.
Methods: A prospective study. All patients who presented to our medical center’s OED between 22:00-06:00 were enrolled. On presentation, all patients filled in a demographic and medical questionnaire, and the attending ophthalmologists filled in another questionnaire on the diagnosis and the treatment that had been provided. Data from electronic/paper medical records were collected and analyzed, and cases were categorized post-factum as urgent or non-urgent.
Results: A total of 1,290 patients (50% females, mean age 38 years) comprised the study group. Of them, 364 (29.7%) were self - referred, 208 (17%) were referred by a general practitioner or an ophthalmologist, and 404 (32.9%) were referred for consultation from within the general ED. Trauma was the most frequent diagnosis (47%), followed by infectious/inflammatory conditions (16%), and 365 (29.3%) cases were categorized as "non-urgent".
Conclusion: Patients who pay nighttime OED visits require ophthalmic care in a range of urgency. We believe it is justified to have in-house on call ophthalmologist during night shift in the ED. However, a significant proportion of the nighttime visits constitute non-urgent cases that could have been treated in ophthalmic primary care facilities. Implying flaws in the structure of the country’s healthcare system by overloading the tertiary care facilities where costs are considerably higher than in the community. Allocation of appropriate resources to such facilities may lead to improved patient management and alleviation of the heavy burden on the public healthcare system.