title: Patterns of ophthalmic referral and emergency presentations to an acute tertiary eye service in New Zealand.
abstract: BACKGROUND
  To establish demographics, referral patterns and clinical characteristics of patients attending an emergency eye service within a major public tertiary teaching hospital and to identify possible targets to improve delivery of patient care.
  
  
  METHODS
  Retrospective study of all patients (N=504) attending an acute eye clinic over a representative 2-week period within Greenlane Clinical Centre, Auckland.
  
  
  RESULTS
  Mean age was 42.4 plus or minus 20.6 years with mean visual acuity of 6/10. Referrals came from: general-practitioners (GP) (26.2%), self-referrals (18.6%), hospital medical-officers (7.4%), accident and emergency clinics (6.6%) and optometrists (2.2%). 39.1% of patients were follow-up reviews. Main presenting symptoms were pain, red eye and reduced vision. Average waiting-time was 119 plus or minus 98 min. Major diagnoses were trauma, uveitis and adenoviral keratoconjunctivitis (AKC). Males were more likely to present with ocular trauma, whereas females were more likely to exhibit uveitis, contact-lens related keratitis and AKC. Outcomes included follow-up (48.2%), referral to speciality ophthalmology care (19.0%), referral to other clinics (5.75%), and discharge (33.7%).
  
  
  CONCLUSIONS
  A significant proportion of presentations could have been appropriately referred to outpatient departments or potentially managed by primary healthcare providers. Potential initiatives to manage excessive workload demands might target prevention of ocular trauma, improved contact-lens education, limiting the spread of AKC and improved GP education.
authors.affiliation: Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand.
authors.forename: Divya
authors.initials: D
authors.lastname: Perumal
authors.forename: Rachael
authors.initials: R
authors.lastname: Niederer
authors.forename: Sue
authors.initials: S
authors.lastname: Raynel
authors.forename: Charles N J
authors.initials: CN
authors.lastname: McGhee
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005128:Eye Diseases / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D009885:Ophthalmology / Q000592:standards / Q000639:trends; D009907:Optometry / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult