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A Fourth of ED Visits for Eye Complaints Aren’t Emergencies

ANN ARBOR, MI – Emergency physicians see it all the time: Panicked patients seeking emergency care for usually benign conditions, such as pink eye or a puffy eyelid.

An article in the journal Ophthalmology points out that nearly 25% of patients presenting to the ED with eye issues actually don’t need to be there. The question raised by University of Michigan researchers is how to better steer those cases so they get the correct level of care.

The analysis involved nearly 377,000 eye-related emergency room visits by adults with private insurance over a 14-year period and found that about 86,500 of these visits were for three conditions that don’t require emergency treatment – conjunctivitis, blepharitis, and chalazion.

Overall, only about 25,300 were for conditions that constitute eye emergencies, study authors point out, with the remainder somewhere in between.

Concerned about the costs of treating non-emergent conditions and how those affect ED crowding, the researchers sought to identify trends. The study finds that use of the ED for non-urgent ocular problems was associated with younger age, black race or Latino ethnicity, male sex, and lower income. Those who sought ED care four times a year or more for other conditions also were likely to present with eye problems.

On the other hand, enrollees with established eye care professionals had a 10% reduced hazard of visiting the ED for a non-urgent ocular condition.

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“Depending on the eye condition, the emergency room is the right choice for some patients, but not the best place for many others,” explained lead author Brian Stagg, MD, an ophthalmologist. “Our findings suggest that eye-care professionals, insurers and emergency providers should work together to help people get the care they need for emerging eye issues, in the right setting.”

The analysis also reveals a 30% increase in all eye-related emergency visits during the study period, especially after 2011, with most of them clearly non-urgent or not clearly urgent. The researchers posit that the rise might be linked to the increase in younger adults covered under their parents’ job-based insurance plans, allowed under the Affordable Care Act since 2010.

Study authors suggest a number of possible solutions to use of the ED for non-emergency eye issues, including greater use of telemedicine with eye specialists and incentives to primary care and eye specialists to expand treatment hours.

“Nearly one-quarter of enrollees who visited the ED for an ocular problem received a diagnosis of a non-urgent condition,” the report concludes. “Better educating and incentivizing patients to seek care for non-urgent ocular diseases in an office-based setting could yield considerable cost savings without adversely affecting health outcomes and could allow EDs to better serve patients with more severe conditions.”