In 2015, the Wilmer Eye Institute of Johns Hopkins Medicine implemented a department-wide same-day access initiative, where each of the nine clinic locations provided same-day appointments. Researchers compared the results of this initiative with emergency department (ED) visits at the Johns Hopkins Hospital before and after the implementation of same-day access. The retrospective analysis revealed that a patient with a non-emergency eye concern would save $782 in charges and 5.75 hours in visit duration by choosing same-day outpatient care rather than an ED visit.

The study tabulated encounters, charges and visit length for outpatients seen on the same day or by previously scheduled appointments. For the ED patients, researchers collected data on volume, diagnoses, charges and length of stay. The number of same-day access patients increased from 22,781 to 26,579 for the first year after its implementation. The mean charge was $258, and the mean clinic transit time was 1.55 hours. For patients seeking eye care in the ED, the mean professional fee was $401, the mean total hospital charge was $1,040, and the mean length of stay was 7.30 hours.

The top four ophthalmic diagnoses for ED patients were conjunctivitis, corneal abrasion, iritis and visual loss, which were unchanged after same-day access implementation. In 2017, a total of 4,062 same-day access patients reported urgency; their estimated savings in charges compared with an ED visit were $580,866 in professional fees and $3,176,484 in hospital charges.

Researchers conclude that urgent eye care delivered in the clinic rather than the ED might achieve substantial savings in time and money.

Singman, EL, Smith K, Mehta R, et al. Cost and visit duration of same-day access at an academic ophthalmology department vs. emergency department. JAMA Ophthalmol. April 25, 2019. [Epub ahead of print].