Assessing the Efficacy of Ophthalmic Transfers to an Academic Level 1 Trauma Hospital: Diagnostic Accuracy and Intervention Rates

Abstract

Objective: To characterize ophthalmic transfers from hospital, emergency department (ED), and urgent care settings to an academic level 1 trauma center and to evaluate the accuracy of transferring diagnoses and rate of intervention after transfer.

Design: Retrospective cross-sectional study SUBJECTS: All patients transferred from outside hospitals, EDs, and urgent care centers accepted by the ophthalmology service at Harborview Medical Center in Seattle, Washington from February 1, 2022 to January 31, 2023.

Methods: Transfer center records were reviewed for patient demographics, transfer facility, method of transport, transfer diagnosis, time from acceptance of transfer to patient arrival, and whether the patient was seen by or discussed with an eye care provider (ophthalmologist or optometrist) prior to the transfer call. Ophthalmology notes were reviewed for final diagnosis, patient disposition, and procedural interventions within 1 month of transfer. Fisher exact tests were used to compare accuracy of transfer diagnoses and rate of intervention or admission between those with and without an in-person evaluation by an eye care provider prior to transfer.

Main outcome measures: Accuracy of transfer diagnoses and rate of procedural interventions or admission after transfer RESULTS: Of 685 total transfers, 6.1% of patients received an in-person evaluation by an eye care provider prior to transfer, and 11.3% were discussed with an eye care provider from the transferring facility. Median (IQR) travel distance was 30 (16-57) miles, and the median (IQR) time from transfer acceptance to arrival was 216 (158-314) minutes. Transfer diagnoses were accurate in fewer than half (48.9%) of cases. Half (50.2%) of all transferred patients were discharged from the ED and underwent no procedural intervention within 1 month of transfer. Patients evaluated in-person by an eye care provider prior to transfer were more likely to have an accurate transfer diagnosis (90.5% vs 66.3%, p < 0.001) and more likely to require admission or procedural intervention (90.5% vs 46.8%, p < 0.001).

Conclusions: Diagnostic accuracy and likelihood of procedural intervention or admission are higher in patients who undergo an ophthalmic or optometric examination prior to hospital transfer, suggesting that standardized pre-transfer evaluation protocols could enhance diagnostic precision and optimize resource use.

Keywords: academic centers; emergency care; hospital transfers; triage accuracy.