EyeFall: is vision assessed in patients admitted with falls in ED?
Free Paper Details
First Author: R.Farwana UK
Co Author(s): J. Roberts M. Zacharaki
NICE guidelines (2013) encourage assessment of visual impairment in all patients admitted following fall. Many studies suggest that the risk of falls in increased by visual impairment. Boyce (2011) estimated the cost of falls associated with sight loss is at least £25.1 million annually, in the NHS. Quite often, assessment of visual acuity is forgotten or deemed unnecessary in the emergency setting. Therefore, we have performed an audit to see how well our emergency department (ED) assesses vision in patients admitted with falls.
This audit took place in the Emergency Department (ED) of Ashford and St Peter’s Hospital, in the UK.
Retrospective data collection was performed on all patients who were admitted in ED under the code ‘fall’, between the dates of 1st November – 5th November 2019, inclusive. ED proformas were searched for any mention of visual acuity or field assessments, use of spectacles, ophthalmic history, or known history of dementia.
For the 60 falls patients assessed, mean age was 76.4 (SD 17.91) and 57% (n=34) were female. 75% (n=49) had fallen in their own home, with 65% (n=39) requiring an ambulance. 52% (n=31) were re-attenders to A&E for falls, and 58% (n=35) of falls were mechanical in nature. 35% (n=39) had a confirmed ophthalmology history. 22% (n=13) were re-attenders with known ophthalmology issues. Spectacle use was noted for just 1 patient, while visual acuity and fields were not assessed at all. Just 17% (n=10) mentioned an ophthalmology history at all. 18% (n=11) had confirmed dementia.
This audit highlights the great improvement required by our ED in assessing vision in patients with falls. We recommend producing a large sticker in the ED proforma with a series of tick boxes to ensure visual fields, and acuity are assessed. We can introduce a 1m Snellen chart to enable acuity to be assessed at the end of the bed, testing the minimum acuity of 6/12, failure of which will warrant further investigation. We plan to re-audit once these changes have been made.