To evaluate the short-term impact of the implementation of a non-mydriatic ocular fundus camera in a busy emergency department (ED) in a metropolitan quaternary care hospital.

Quality improvement project with systematic prospective collection of data from patients who had ocular fundus photographs taken in the ED for visual complaints, headaches, neurologic symptoms, “papilledema”, hypertensive crisis. We collected demographic information, indication for fundus photographs, who ordered photographs, timing of photographs, final diagnosis, and whether photographs had an impact on patients’ length of ED stay and final outcomes.

Over 4 months, 385 patients had photographs (ordered by ED 89.3%, ophthalmology 7.7%, neurology 3.0%). Reasons included visual complaint 34.8%, headache 14.3%, papilledema 14.6%, other neurologic complaints 35.3%, hypertension 0.8%, diabetes 0.3%. Photographs were interpreted remotely, avoiding ophthalmology or neurology in-person consultation in 10.9%. Obtaining photographs took <5 minutes (60.2% high quality; 75.2% able to exclude emergent findings). Photographs accelerated the management/disposition of patients with acute disorders in 56.3%, including 13 acute central retinal arterial occlusions, 5 giant cell arteritis, 44 papilledema.

Incorporating a non-mydriatic ocular fundus camera into the ED workflow can be used as a substitute for non-ophthalmology provider funduscopic examinations in most cases, facilitating remote fundus interpretation by ophthalmologists and real-time remote recommendations without seeing patients in person. These positive preliminary results obtained only 4 months after implementation of the camera suggest that this strategy reduces the overall ED stay and accelerates the diagnosis of urgent vision- or life-threatening conditions, resulting in improved patient outcomes. Further data will be collected and results of the first 9 months (estimated >1000 consecutive patients) will be presented at the AAN meeting.