Ophthalmology Information

The One Portal now has LLUMC/CH Eye Disorder protocol guidelines. The Ophthalmology Department is requesting we use these protocols prior to consulting the resident for evaluation in the ED. 

The protocols are found under Clinical Desktop --> Clinical Guidelines MC ( or CH) --> Eye Disorders : 

https://one.lluh.org/guidelines-medical-center

 The protocols most specific for ED provider active management are: 

• Acute flashes / floaters: Many patients should be booked directly to our eye clinic for eval and Tx without ED Ophthalmology Consultation 

• Central Retinal Artery Occlusion:   we now also have the CRAO clinical trial in addition to the HBO treatment option - see attachments 

• Globe rupture : Ensure that both IV Vancomycin and Ceftazidime are started as soon as globe rupture is confirmed and prompt Orbit CT is obtained

• Globe trauma protocol : evaluation should be performed by ED provider per protocol before consulting Ophthalmology 

• Management of Glaucoma Crisis: Evaluation and initial treatment should be initiated prior to discussing with/ consulting Ophthalmology 

• Non-traumatic Red Eye : Many patients can be managed without an Ophthalmology Consult following this protocol and scheduled for timely follow-up. 

For IEHP patients, there is ample availability at the SAC eye clinic. For patients with insurances that the Eye Clinic accepts, which is most others, we are committed to ensure timely outpatient follow-up. We also assist in the redirection of patients who are contracted with other eye providers in the region ( Ex Optum, CA Eye Care, Kaiser). 

Per ophthalmology:

Our current process for ED follow ups is as follows:

From ophtho clinic schedule coordinator Susannah Hundley:

"Residents will see patient in ED and send a secure chat to me with follow up instructions, we will schedule patients accordingly. If we are not contracted with patients’ insurance, we will let patient know to call their pcp to get referral to contracted provider. If patient has an HMO our referral coordinator will use the residents ED note to request authorization. 

Patients that are seen in urgent care:

One of the nurses will call or email Araceli Mora or I and let us know they have a patient that needs to be seen and we will provide them with an appointment. These are mostly patients that are currently in urgent care that are needing same day, or 1-2 day follow up with us. The urgent care doctor will place an ambulatory referral in the system for approval. Since one of our doctors or residents haven’t seen these patients, we are not able to request the initial authorization.  

Both these processes seem to work well. I am ok with ED nurses sending me a secure chat as this works best since I am always logged into LLEAP. Email is ok, but I might not see it right away." 

Since we have mostly subspecialists working in our LLU Clinic system, it is best to have my staff coordinate with ER staff for LLUH ED follow-ups. We can ensure the proper providers are seeing the patients. 

I received confirmation from Dr Travis Losey that SAC Eye clinic “one click” scheduling is available from the “MC Emergency” context with open slots for ophthalmology at SAC.