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The effect of visual acuity measurement on triage effectiveness in an ophthalmic emergency department
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The effect of visual acuity measurement on triage effectiveness in an ophthalmic emergency department
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The effect of visual acuity measurement on triage effectiveness in an ophthalmic emergency department
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Journal Article
The effect of visual acuity measurement on triage effectiveness in an ophthalmic emergency department
2025
Overview
Purpose
The effect of pre-triage visual acuity (VA) measurement on triage accuracy in a busy ophthalmic casualty department was investigated as a possible means to improve triage quality.
Methods
All 576 patients attending the accident and emergency department (A&E) at the Birmingham and Midland Eye Centre (BMEC) over a period of 4 days were included in this prospective cross-sectional study. Patients were assigned to two groups: those who underwent a VA measurement prior to triage (
n
= 242) and a control group who did not have a VA measurement (
n
= 234). Clinicians who were masked from the allocation also assessed whether they agreed with the triage decision after assessing each patient.
Results
Triage outcomes were recorded for 469 (81%) patients. Those with a pre-triage VA measurement were more likely to be assessed as more urgent (
p
= 0.005) and less likely to be discharged (
p
= 0.04). 248 (43%) patients had clinician response with corresponding triage records, of which 136 (55%) had prior VA measurement and 112 (45%) were in the control group. Clinicians responded that patients with VA measurement prior to triage were more accurately triaged than the control group (66% and 54%;
p
= 0.03).
Conclusion
VA measurement prior to triage can help improve triage accuracy and allow better allocation of resources at an overcrowded eye-dedicated emergency department. However, waiting times may increase due to longer triage duration and more patients to be triaged into urgent pathway. Greater staffing resources may be necessary to complement the proposed change to avoid undermining triage efficiency.
Key messages
What is known
According to the Emergency Eye Care Commissioning Guidance published by the Royal College of Ophthalmologists in 2020, a substantial number of UK hospitals do not reference visual acuity measurements at triage. However, there is a continuous surge in demand for emergency eye care services in the UK, calling for improvements in triage as its relevance increases.
What is new
Patients with pre-triage VA measurement are found to have a more accurate triage outcome.
Pre-triage VA measurement reduces under-triaging.
Propose a new triage standard considering visual acuity results of patients.
