JAMA Ophthalmology Journal Club Slides: Supply and Demand for Teleophthalmology in Emergency Departments Wedekind L, Sainani K, Pershing S. Supply and perceived demand for teleophthalmology in triage and consultations in California emergency departments. JAMA Ophthalmol. Published online March 24, 2016. doi:10.1001/jamaophthalmol.2016.0316.

Introduction Emergency departments may face limited access to ophthalmologists in rural settings, with possible delays in care, external referral, and/or transfer to other facilities. Telemedicine has been applied in other contexts in emergency care and ophthalmology and has been shown to have promise for emergency ophthalmology evaluation. Teleophthalmology evaluation has the potential to expand eye care access in areas with little to no existing in-person coverage; however, it is not yet the standard of care for addressing emergency eye problems in underserved areas. Objectives: To evaluate perceived current need and availability of ophthalmologist coverage in California emergency departments. To evaluate the potential effect of telemedicine for ophthalmology triage and consultation.

Methods Study Design: Surveys were remotely administered to assess facility characteristics and resources as well as perceived usefulness of teleophthalmology consultation. Participants were asked to respond yes or no regarding emergency department access to ophthalmologists, need for patient transfer, any ophthalmology-related encounters annually, and applicability of specific advantages or disadvantages for teleophthalmology. They were also asked to quantify the perceived value of teleophthalmology for remote triage and consultation on a scale of 1 to 5. Participants: Emergency department nurse managers and physicians from all emergency departments listed in the California Office of Statewide Health Planning and Development (OSHPD) database were individually surveyed. Data Analysis: Descriptive statistics and multivariable linear regression. Limitations: Only 1 nurse manager and 1 physician were surveyed at each facility; there were fewer rural than nonrural facilities; and 67 of 254 OSHPD- indexed emergency departments in California did not have data available at the time of the study and were excluded.

Results Of the 187 emergency departments surveyed, 18 of 37 rural facilities (48.6%) reported existing emergency ophthalmology coverage, compared with 112 of 150 nonrural facilities (74.7%). 181 of 187 emergency departments (98.6%) reported seeing patients for eye-related encounters in 2014. 28 of 37 rural facilities (75.7%) reported having to transfer patients with eye-related encounters to another facility for care in 2014, compared with 68 of 150 nonrural facilities (45.3%). Just fewer than half (47.1%) of the facilities currently use telemedicine in some form (slightly higher among rural facilities [48.6%] than nonrural [46.7%]). 123 of 187 nurse managers (65.8%) and 58 of 121 physicians (47.9%) rated teleophthalmology as having high or very high perceived value for patient triage.

Emergency Department Survey Resultsa

Results Perceived Value of Emergency Teleophthalmology for Triage and Consultation

Advantages and Disadvantages of Teleophthalmology Results Advantages and Disadvantages of Teleophthalmology

Comment Availability of emergency ophthalmology coverage is limited—particularly among rural emergency departments in California—necessitating more patient transfers and delays in care. Our study finds moderately high interest and perceived value for teleophthalmology to aid in remote triage and/or consultation, especially by nurse managers and physicians in rural facilities. Potentials to increase triage efficiency and fill coverage gaps were significantly predictive of perceived value. Costs of installation, maintenance, and/or contracting and the reliability and clinical accuracy of images were the most cited potential barriers to adoption. Teleophthalmology may play a role in mitigating coverage gaps in emergency ophthalmic care, warranting further study in a clinical setting.

Conflict of Interest Disclosures Contact Information If you have questions, please contact the corresponding author: Suzann Pershing, MD, MS, Byers Eye Institute at Stanford University, 2452 Watson Ct, Palo Alto, CA 94303 (pershing@stanford.edu). Funding/Support The Human Biology Research Experience Grant Program of the Stanford University Department of Human Biology supported Ms Wedekind’s residence at Stanford University during the data collection phase. Conflict of Interest Disclosures All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Pershing reported serving as a consultant/advisory board member for Digisight Technologies. No other disclosures were reported.