title: Reliability of ophthalmic accident and emergency referrals: a new role for the emergency nurse practitioner?
abstract: OBJECTIVE
  Annual attendances at the accident and emergency (A&E) department of St Bartholomew's and The Royal London NHS Trust exceed 100,000 people of which 6% are ophthalmic. This study evaluated the accuracy of eye referrals from A&E senior house officers (SHOs) and emergency nurse practitioners (ENPs) and the impact any inaccuracies may have had on out of hours work.
  
  
  METHODS
  Over a four week period a record of all referrals from the A&E department was made. The doctor receiving the referral made a note of clinical variables as reported by the referring clinician. When the patient was subsequently reviewed by an ophthalmologist, a record was again made of these findings. Any discrepancies were recorded.
  
  
  RESULTS
  A total of 67 patients were recruited. ENPs were found to be consistently more accurate than SHOs in every aspect of the assessment, most notably in visual acuity (p = 0.0029), and provisional diagnosis (p = 0.012). Furthermore, had the examination findings been accurate, 58% of all SHO referrals seen after hours would have been triaged to the next available clinic but only 10% of ENP referrals could have been seen at the next clinic session (p = 0.027).
  
  
  CONCLUSIONS
  This study found ENPs to be more accurate than A&E SHOs in history taking, recording visual acuity, describing ocular anatomy, and making provisional diagnoses. A significant reduction in out of hours ophthalmic workload may be achieved in the authors' unit if ENPs were to see all eye emergencies.
authors.affiliation: Department of Ophthalmology, St Bartholomew's and the Royal London NHS Trust, London, UK. daniel_ezra@hotmail.com
authors.forename: D G
authors.initials: DG
authors.lastname: Ezra
authors.forename: F
authors.initials: F
authors.lastname: Mellington
authors.forename: H
authors.initials: H
authors.lastname: Cugnoni
authors.forename: M
authors.initials: M
authors.lastname: Westcott
mesh_terms: D002983:Clinical Competence; D015400:Clinical Nursing Research; D003951:Diagnostic Errors; D004630:Emergencies; D016529:Emergency Nursing / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005131:Eye Injuries / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008131:London; D008505:Medical Staff, Hospital / Q000592:standards; D009722:Nurse Practitioners / Q000592:standards*; D024802:Nurse's Role; D011446:Prospective Studies; D012017:Referral and Consultation / Q000592:standards*; D014218:Triage / Q000592:standards; D014792:Visual Acuity