THE ROLE OF OPHTHALMIC TRIAGE AND THE NURSE PRACTITIONER IN AN EYE-DEDICATED CASUALTY DEPARTMENT

Purpose To evaluate the appropriateness of triage decisions in a busy ophthalmic casualty department and to assess the diagnostic and manage ment skills of eye-dedicated nurse practitioners. Methods Three hundre d and one consecutive patients attending the Birmingham and Midland Ey e Centre (BMEC) accident and emergency (A&E) department over a 2 week period were included in this prospective study. Patients were categori sed in terms of urgency in concordance with strict guidelines, and the agreement between the final diagnosis and this system of prioritisati on was then investigated. To evaluate nurse practitioner (NP) skills, all patients seen and managed by a NP were also assessed by the most s enior doctor in casualty at the time in a masked fashion. Waiting time s and a breakdown of waiting times were also calculated. Results Upon establishment of a diagnosis, triage category allocation was found to be appropriate in all 301 cases, Fifty patients (16.67%) were seen by the NP. Of these the supervising doctor concurred with the NP diagnosi s in all cases and with the proposed management in 96% of cases. The m ean waiting time (+/- SD) was 83.43 +/- 45.84 min with a range of 5-33 5 min. The delay before being attended to was greater for less urgent cases as categorised by the triage system. Conclusion This study confi rms the high standard of diagnostic and management skills of the ophth almic NP and indicates that the triage system of patient prioritisatio n is accurate. Waiting times in the A&E department remain unacceptable and ways oi: addressing this include improved ophthalmic training of general practitioners, diverting a greater proportion of non-acute cas es to the primary care clinic and expanding the role of the NP.