Real-World Performance of a New Online Eye Symptom Triage Tool (Eye+Dot) in an Emergency Eye Clinic: Mixed Methods Evaluation Study.

Background: Previous studies indicate that 37% to 92% of patients presenting to hospital emergency eye clinics (EECs) could be seen in commissioned community optometrist enhanced service schemes (ESSs), reducing pressure on hospital services and moving eye care into the community. Digital triage tools may have the potential to support effective triage and use of ESSs. Objective: This study sought to evaluate the effectiveness of a recently developed online symptom triage tool in real-world EEC practice and assess its usability and acceptance by patients. Methods: This was a prospective, real-world study comparing automated dispositions suggested by the eye+dot online triage tool with nursing triage, using ophthalmologist dispositions and subsequent clinical findings as the reference standard. Patients aged 13 years and older were sent an SMS text message invitation to use eye+dot prior to their scheduled EEC appointment. Age, time required to complete the symptom questionnaire, and acceptability (using an in-application visual Likert scale) were also recorded. The accuracy of the different triage methods at assigning patients to eye assessments within 24 hours, 48 to 72 hours, or a week based on symptom urgency was compared. Eye+dot's accuracy in identifying patient suitability for ESSs was analyzed. Results: A total of 282 eligible patients with a mean age of 53.14 (SD 19.8; range 13-92) years were included. The mean eye+dot test duration was 5.6 (SD 2.4) minutes, with 80.4% (168/209) of patients rating the test as good or excellent. For high-acuity symptomatology (defined via retrospective ophthalmologist recommendation for assessment within 24 hours), sensitivity was similar between eye+dot and nurse triage (58/76, 76.3%; 95% CI 65.2%-85.3% and 65/76, 85.5%; 95% CI 75.6%-92.5%, respectively; P=.19). However, eye+dot specificity was significantly higher (132/206, 64.1%; 95% CI 57.1%-70.6% vs 47/206, 22.8%; 95% CI 17.3%-29.2%; P<.001). Of 224 urgent nursing dispositions, 203 (90.6%) patients were downrated (considered suitable for nonurgent assessment) by ophthalmologist assignment, and 93 (41.5%) were downrated by eye+dot. In total, 90.8% (256/282) of the patients were considered suitable for ESS assessment through eye+dot triage. A total of 56.6% (145/256) of these patients subsequently received only medical advice without specialist investigations or management at their EEC visit, suggesting suitability for community eye care. Conclusions: Eye+dot-automated triage has similar sensitivity but superior specificity to nursing triage for identifying high-acuity symptomatology. This small study suggests its potential to improve patient scheduling in EECs throughout the working week and improve the use of community services. A larger study is planned to establish the utility of the triage tool and develop an implementation model to scale up and spread the technology.