PREPARE FOR THE WORST TO PROVIDE YOUR PATIENTS THE BEST

AT TIMES, a patient will present to the office with ocular signs and/or symptoms that warrant immediate attention and possible referral to an emergency room (ER) or require emergent/after-hours consultation with ophthalmology.

To aid your patients in getting the best care, establish a relationship with ER staff, recognize an emergency and provide the receiving location with all the relevant case information.

ESTABLISH A RELATIONSHIP WITH ER STAFF

Create relationships with members of nearby hospitals, including the ER staff, and obtain phone numbers for these personnel. This can help expedite care for your patient(s), when necessary. Also, become familiar with the ERs that have ophthalmology “on call” for consultation. (It is invaluable to cover all your bases.)

Similarly, when encountering an ocular emergency, it is essential to know local ophthalmologists’ emergency management policies and contact information. To do so, review the local ophthalmologist locations and specialties in the community. By identifying both generalists and specialists, you can contact the providers — either via phone, or even better, in person at their offices — to gather addresses and phone information. Often ophthalmology practices have a contact person within their staffs who assists in the coordination of patient care. Either the doctor and/or the office staff can provide the optometrist with phone numbers to doctors’ lines and emergency contact procedures for the office(s).

RECOGNIZE AN EMERGENCY

While ocular urgencies, such as diabetic macular edema or recurrent corneal erosions, require timely management, such conditions do not always have the same accelerated time requirements for intervention as ocular and/or systemic emergencies. There is a group of conditions that may be considered “true” ocular emergencies. (See “Ocular Emergencies,” below.) These clinical symptoms, or findings, are associated with either diagnoses that may lead to blindness or potentially systemic complications, if not addressed promptly.

PROVIDE THE INFORMATION

When you encounter an ocular emergency, directly contact the designated ER’s primary physician or triage staff member, if possible, and provide him or her with detailed information regarding the patient’s emergency. Also, have the patient take with him or her a referral letter and any further documentation necessary. The referral letter should include possible differential diagnoses and recommendations for potential testing and evaluations, including which imaging and serology should be performed, in addition to your working diagnosis and any pertinent findings.

Of note: Most hospital ER departments will begin imaging studies using less costly, less specific testing, such as a CT scan instead of an MRI. Therefore, if an MRI is necessary based on the clinical findings, state this in the referral letter.

EASE THE PATH

An emergency room physician’s job is to stabilize patients for referral to the appropriate department or specialist for further evaluation. Generally, ER doctors do not have very long relationships with patients, but do initiate treatment for conditions that involve all areas of medicine. Following the above steps will help to provide your patients with the smoothest experiences and best possible outcomes for their emergencies. OM

DR. SHECHTMAN is a professor of optometry at Nova Southeastern University College of Optometry, where she serves as a clinician in the Eye institute. She is also the coordinator of the diabetes and macula service and the director of interdisciplinary education. Dr. Shechtman is a member of ASCO’s Inter-professional Education and Collaborative Practice Committee, a fellow of the AAO and the Optometric Retinal Society (ORS).

DR. TYLER is an associate professor and primary care module chief at Nova Southeastern University College of Optometry in Davie, Fla. She is a fellow of the AAO and a member of the AOA. Dr. Tyler has lectured on a variety of topics in optometry, including systemic associations with ocular complications and anterior segment disease. You may reach her at jtyler@nova.edu.