Clinical Study
Eye (2007) 21, 976–983; doi:10.1038/sj.eye.6702374; published online 28 April 2006
Evidence-based practice in acute ophthalmology
Conflict of interest: None.
Presentations in the meetings: (1) Free paper presentation in 2nd SERI ARVO, Singapore, 16–20 February 2005. (2) Rapid fire presentation in The Royal College of Ophthalmologists Annual Congress, 17–19 May 2005
1Wolverhampton and Midland Counties Eye Infirmary, Wolverhampton, UK
Correspondence: S Sandramouli, Wolverhampton and Midland Counties Eye Infirmary, Compton Road, Wolverhampton WV3 9QR, UK. Tel: +44 1902 695828; Fax: +44 1902 695841; E-mail: samouli@aol.com
Received 18 September 2005; Revised 16 January 2006; Accepted 15 March 2006; Published online 28 April 2006.
Abstract
Aim
To study the overall level of evidence-based practice in an accident and emergency eye unit in the UK and evaluate the extent of evidence-based practice by ophthalmologists and nurse practitioners (NPs).
Methods
The case notes of all new patients attending our accident and emergency department for a period of 1 week were reviewed prospectively. For each case, the diagnosis at presentation and its intervention was ascertained. A literature search using Medline and Cochrane library was performed to assess the level of evidence provided for each diagnosis–intervention pair. Each diagnosis–intervention pair was evaluated and graded to assess the best level of evidence provided.
Results
A total of 474 new patients attended the eye casualty during the study period. No diagnosis was made in 27 cases and they were excluded from the analysis. Out of 447 patients, 308 (68.9%) cases were managed by NPs and 139 (31.1%) by doctors. A total of 294 (65.8%) patient interventions were based on evidence from systematic reviews, meta-analysis and randomised-controlled trials, of which 223 were managed by NPs and 71 by ophthalmologists. This difference was statistically significant with P<0.001. One hundred and seven (23.9%) interventions were supported by evidence from prospective and retrospective trials.
Conclusion
This study demonstrated that two-thirds of interventions were based on the highest level of evidence and was comparable to studies performed in other specialities. It also highlights the advanced role of trained NPs in acute ophthalmology.
Keywords:
evidence-based medicine, acute ophthalmology, nurse practitioners
