Outcomes of interfacility ophthalmology transfers to a quaternary emergency department

Interfacility emergency transfer is a common mechanism for addressing specialty care. Ophthalmology presents unique challenges in emergency settings, as evaluation of acute eye concerns often requires specialized equipment and expertise. Patients are frequently transferred to quaternary centers for ophthalmologic evaluation, though the disposition and follow-up of these transfers remain poorly characterized.

We conducted a retrospective analysis of transfers from urgent care or an outside emergency department (ED) to a single quaternary care ED between 2017 and 2025 with ophthalmology as the sole consulting service. Outcomes included ED disposition, time until outpatient ophthalmology follow-up, and outpatient operative intervention within one week of discharge. Patients were characterized by arrival time and distance traveled. We used ED discharge without imaging as a proxy for potential ophthalmology clinic evaluation.

3072 ophthalmology-only transfers were identified. 2156 (70.5%) were discharged, 378 (12.3%) were sent to the operating room, and 504 (16.4%) were admitted. 163 (5.3%) transfers underwent outpatient operative procedures within 7 days of ED presentation but after ED discharge. Median travel distance was 34.5 miles with a range of 1 to 2891. Of the discharged patients, 1684 were discharged without imaging and 698 attended an outpatient visit within 7 days.

More than half of ophthalmology-only ED transfers were discharged without imaging, with many receiving outpatient evaluation. These findings suggest that ED transfer may facilitate access to ophthalmologic evaluation when local specialty care is limited. Further research is needed to determine which transfers may be appropriate for outpatient evaluation.