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. 2025 Apr;263(4):1183-1187.
doi: 10.1007/s00417-024-06705-5. Epub 2024 Dec 9.

The effect of visual acuity measurement on triage effectiveness in an ophthalmic emergency department

Hoi Ying Emily Chan #  1 , Jonathan S C Cheng #  1 , Adam Bharmal  2 , Velota Ct Sung  3
Affiliations

The effect of visual acuity measurement on triage effectiveness in an ophthalmic emergency department

Hoi Ying Emily Chan et al. Graefes Arch Clin Exp Ophthalmol. 2025 Apr.

Abstract

Purpose: The effect of pre-triage visual acuity (VA) measurement on triage accuracy in a busy ophthalmic casualty department was investigated as a possible means to improve triage quality.

Methods: All 576 patients attending the accident and emergency department (A&E) at the Birmingham and Midland Eye Centre (BMEC) over a period of 4 days were included in this prospective cross-sectional study. Patients were assigned to two groups: those who underwent a VA measurement prior to triage (n = 242) and a control group who did not have a VA measurement (n = 234). Clinicians who were masked from the allocation also assessed whether they agreed with the triage decision after assessing each patient.

Results: Triage outcomes were recorded for 469 (81%) patients. Those with a pre-triage VA measurement were more likely to be assessed as more urgent (p = 0.005) and less likely to be discharged (p = 0.04). 248 (43%) patients had clinician response with corresponding triage records, of which 136 (55%) had prior VA measurement and 112 (45%) were in the control group. Clinicians responded that patients with VA measurement prior to triage were more accurately triaged than the control group (66% and 54%; p = 0.03).

Conclusion: VA measurement prior to triage can help improve triage accuracy and allow better allocation of resources at an overcrowded eye-dedicated emergency department. However, waiting times may increase due to longer triage duration and more patients to be triaged into urgent pathway. Greater staffing resources may be necessary to complement the proposed change to avoid undermining triage efficiency.

Keywords: Emergency; Ophthalmology; Triage; Visual acuity.

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Conflict of interest statement

Declarations. Ethics approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Clinical Effectiveness Team of the Birmingham and Midland Eye Centre (Approval ID: 2426) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As confirmed by the clinical governance team, this is a service improvement project and not a research project. The VA assessment was simply assessed earlier in the triaging stage, so no additional experimental assessments or treatments were added, and no changes were made to the patient treatment pathway. Therefore, ethics approval was not deemed necessary prior to the commencement of the project. Consent to participate: Informed consent was obtained from all individual participants included in the study. Informed consent: Informed consent was obtained from all individual participants included in the study. Competing interests: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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