Confidence of Emergency Department doctors in managing ophthalmic emergencies: a systematic review

Jessica Mendall; Abraham Tolley; Veronica Parisi; Stella Hornby; Ruth Brown; Victoria Nowak

doi:10.1038/s41433-024-03115-z

Confidence of Emergency Department doctors in managing ophthalmic emergencies: a systematic review

Eye (Lond). 2024 May 10. doi: 10.1038/s41433-024-03115-z. Online ahead of print.

Authors

Jessica Mendall¹, Abraham Tolley², Veronica Parisi³, Stella Hornby⁴, Ruth Brown⁵, Victoria Nowak⁶

Affiliations

¹ University College London, London, UK. jessica.mendall.20@ucl.ac.uk.
² University of Cambridge School of Clinical Medicine, Cambridge, UK.
³ University College London Library Services, London, UK.
⁴ Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁵ Imperial College Healthcare NHS Trust, London, UK.
⁶ The National Hospital for Neurology and Neurosurgery, London, UK.

PMID: 38729998
DOI: 10.1038/s41433-024-03115-z

Abstract

Background: Eye emergencies constitute a significant portion of attendances to general Emergency Departments (EDs) in the UK, therefore it is important to assess the confidence of doctors who work in this setting in managing these potentially sight- and life-threatening presentations. This systematic review aims to assess the confidence of UK doctors working in general EDs in managing ophthalmic emergencies.

Methods: MEDLINE (Ovid), EMBASE (Ovid), ProQuest Central and Web of Science databases and grey literature were searched from inception to 1 October 2022 for publications that (1) featured doctors working in UK general EDs, (2) assessed doctors' confidence in managing ophthalmic emergencies, (3) contained original data, (4) were full-text, and (5) written in English. Methodological quality was assessed using the AXIS tool.

Results: 462 articles were screened, and 7 papers included for data extraction, which collectively assessed the confidence of 956 doctors working in EDs in managing ophthalmic emergencies. There was a widespread lack of confidence amongst foundation doctors, which has worsened over time. Most doctors lacked confidence in performing funduscopy and using the slit-lamp, and considered formal ophthalmology training received in EDs to be inadequate.

Conclusions: Evidence suggests a lack of confidence amongst foundation doctors in managing ophthalmic emergencies. High-quality evidence investigating the confidence amongst more experienced Emergency Medicine (EM) physicians was lacking. It is important to assess why foundation doctors feel so ill-prepared to manage eye emergencies and develop further ophthalmic training for doctors working in EDs. Further investigation exploring the confidence of EM trainees and consultants is required.