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EP-113 - Eye on Value - Teleophthalmology in the Emergency Department

Sunday, April 29
4:05 PM - 4:20 PM
Location: Education Zone, Booth 2416, Screen 2

Currently, in the United States, most community hospital emergency departments (EDs) do not have an ophthalmologist on call. Personnel without specific training in ophthalmic emergencies evaluate most patients who present to their community ED for an eye problem. Management frequently requires referral or transfer, often by ambulance, for expert evaluation to an ED at an academic or tertiary care hospital. Additionally, in emergency settings when specialized providers are available, patients may be examined on site, but wait times may be several hours. Major drawbacks of the current standard of care include limited access to ophthalmology evaluation in community hospital EDs, long wait times, increased costs if transfer is deemed necessary, delay to diagnosis with risk of disease progression over the wait period which may lead to irreversible vision loss and loss to follow-up.
Until recently, the practice of transferring patients with ocular conditions was standard of care at a local community hospital emergency department. Of all transfers from the community hospital ED to the ED at the nearest academic tertiary care institution, 40% are for eye conditions, and many are ultimately deemed unnecessary transfers. Most patients who present to an emergency room with an eye complaint will have a minor condition that likely can be safely diagnosed and managed remotely with a high-resolution camera. Tele-ophthalmology with video visits is not common in ophthalmology as specialized equipment, such as a slit lamp, is often necessary and requires skilled users. However, most patients who present to the ED with an eye problem have minor anterior segment conditions which can be evaluated with a simple high-resolution camera, which does not require a highly trained operator.
In hopes of improved outcomes, a pilot initiative to evaluate ocular emergencies using remote technology for a video visit combined with a high-resolution hand-held camera was implemented at the community hospital ED. Through the telemedicine program, when patients are triaged and noted to have an eye problem, they are given the option to connect with an ophthalmologist by video for remote evaluation rather than wait for an in-person examination by a provider not trained in eye care.
Since implementation of this technology three months ago, 8 patients have been remotely evaluated and 7 were deemed to not require transfer to a second ED. All patients were seen in person for a follow-up evaluation, which confirmed the telemedicine diagnosis in each case. Each avoided transfer saved the patient significant waiting time, up to 100 miles travel if traveling by car and the health system between $4,000 and $6,000 if an ambulance transfer was avoided.
Ophthalmology tele-consultation in the ED allows accurate diagnosis and demonstrates considerable savings incurred by the health care system by reducing patient transfers and a second emergency admission. Patient time and transportation savings are also realized. Tele-ophthalmology in the community hospital ED is a viable alternative to transfer to a tertiary care center for in person evaluation by an eye care provider.

Learning Objectives:

Ingrid Zimmer-Galler

Executive Clinical Director, Office of Telemedicine and Associate Professor of Ophthalmology
Johns Hopkins Medicine

Dr. Zimmer-Galler is the Executive Clinical Director of the Johns Hopkins Office of Telemedicine and an Associate Professor of Ophthalmology. Her main research interest over the past decade has been in tele-ophthalmology including developing and implementing a large-scale telemedicine diabetic retinopathy screening program. She is currently piloting an emergency department ophthalmology tele-consult project with the goal of reducing transfers from community hospital EDs to the Johns Hopkins Hospital ED. There are currently more than 30 active telemedicine programs at Johns Hopkins which are facilitated through the Office of Telemedicine. She has previously served on the Board of Directors for the American Telemedicine Association and is presently a member of the telemedicine workgroup for the American Academy of Ophthalmology. She is a busy vitreoretinal surgeon and also participates in clinical trials for macular degeneration, diabetic retinopathy and other retinal diseases.

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Rebecca Canino

Administrative Director
Johns Hopkins Medicine

Rebecca Canino has been with Johns Hopkins Medicine since 2007. Her background includes a long history with international nonprofit startups, and when she returned stateside, the innovation, collaboration, creativity, and compassion for patients that she found at Hopkins fit her personal mission perfectly. She is passionate about reaching as many people as possible with the clinical excellence and game-changing research of our physicians. Rebecca believes that Telemedicine is the optimal platform for our shared mission: improving the health of our community and the world.

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Fasika Woreta

Assistant Professor of Ophthalmology
Johns Hopkins Wilmer Eye Institute

​Fasika A. Woreta, MD, MPH is Assistant Professor of Ophthalmology at the Johns Hopkins Wilmer Eye Institute. She is Director of the Eye Trauma Center at Wilmer as well as Associate Residency Program Director. She is involved in tele-ophthalmology projects in the Emergency Department in particular to reduce transfers between hospitals and decrease costs to the health care system.

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