Potential Demand for Tele-Ophthalmology Consultation in California Emergency Departments

BACKGROUND:Rural hospitals and emergency departments often suffer from limited resources (eg. specialty consultants) leading to coverage gaps in underserved areas. Telemedicine consultation (including diagnostic imaging and live video and/or phone consultation) is a new and growing phenomenon which may expand availability of specialty consultation and triage. We evaluated current state of ophthalmologist availability for California emergency departments and potential impact of tele-ophthalmology consultation. METHODS:A representative database of 254 California emergency departments was developed from OSHPD data, classifying each according to care delivery status. A standardized survey instrument was developed and administered to a nurse manager and a physician in each emergency department, to evaluate current availability of ophthalmologists for live consultation, as well as interest and predicted impact of tele-ophthalmology consultation if it were available. RESULTS: 254 nurse managers were surveyed: Of their EDs, 16.9% are rural, 50.3% were unable to provide emergency eye care to at least one patient in 2014 (including 76.7% of the rural EDs), and 29.9% had no on-call ophthalmologists on-site. Although 46.8% of hospitals used other forms of telemedicine, 0% employed live video consultation. Nurse managers rated the potential value of a tele-ophthalmology consultation as 3.77/5 for helping triage, and 3.5/5 for live video consultations, on a scale of 1 (very low) to 5 (very high). CONCLUSIONS: Availability of ophthalmology coverage for emergency eye care is limited, particularly among rural emergency departments in California. Surveyed emergency departments demonstrated moderately high interest and perceived value for remote tele-ophthalmology consultation coverage.