Emergency physician-directed streamlined access to ophthalmology consultations: evaluation of a direct access pathway

OBJECTIVE: To evaluate the use, safety, and diagnostic accuracy of referrals sent through a direct access pathway for ophthalmic complaints from 2 emergency departments (EDs) to a tertiary emergency ophthalmology clinic. DESIGN AND PARTICIPANTS: Cohort study of all referrals from two academic EDs to the Urgent Eye Care Clinic (UECC) at Kingston Health Sciences Centre between July 2, 2024, and March 21, 2025. METHODS: Referral data were extracted from electronic medical records, including patient demographics, referral details, and provisional diagnoses. Clinic notes were reviewed to identify the level of training of the primary assessor and the UECC diagnosis. Agreement between provisional and UECC diagnoses was assessed for both diagnostic accuracy and urgency. RESULTS: Two hundred forty-six referrals met the inclusion criteria. The mean ± SD time from referral to assessment was 1.15 ± 0.92 days, with 72% of patients seen within 1 calendar day. Among referrals containing a provisional diagnosis (n = 171), 85% were appropriately triaged as emergent or urgent. Agreement between provisional and final diagnoses occurred in 44% of the cases. ED physicians most accurately identified posterior segment pathology (97.5% agreement), whereas anterior segment disease was frequently misclassified. Overcalling of urgency was common (41%), while undercalling occurred in less than 5% of referrals. CONCLUSIONS: Overall, the direct referral pathway presents a safe and effective alternative to the fielding of ED referrals. Most referrals were appropriate, although some were for nonurgent concerns. Strengthening ophthalmic education and encouraging interdisciplinary communication might further optimize referral accuracy.