Real-World Performance of a new Online Eye Symptom Triage Tool (eye+dot) in an Emergency Eye Clinic: Mixed Methods Evaluation Study (Preprint)

BACKGROUND Previous studies indicate that 37-92% of patients attending hospital emergency eye community. Digital triage tools may have the potential to support effective triage and utilisation of the ESS. OBJECTIVE The objective of this study was 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 standard. Patients aged 13 years and over were sent an SMS invitation to use eye+dot prior to their scheduled EEC appointment. Age, test duration and acceptability (using an in-app visual Likert score) were also recorded. The accuracy of the different triage methods at assigning patients to eye assessments within 24 hours, within 48-72 hours or within a week based on symptom urgency was compared. Eye+dot’s accuracy in identifying patient suitability for EES was analysed. RESULTS 282 eligible patients with a mean age of 53.14 (range 13-92) were included. Mean eye+dot test duration was 5.6+/- 2.4 mins with 80.4% of patients rating the test good or excellent. For high acuity symptomatology (defined by retrospective ophthalmologist recommendation for assessment within 24 hours), sensitivity was similar for eye+dot and nurse triage: 76.3% (95CI: 65.2-85.3) versus 85.5% (95CI: 75.6-92.5) respectively (P=0.19). However, eye+dot specificity was significantly higher: 64.1% (57.1-70.6) versus 22.8% (17.3-29.2) (P<.001). Of 224 urgent nursing dispositions, 203 (90.6%) patients were down-rated (considered suitable for non-urgent assessment) by ophthalmologist assignment and 93 (41.5%) by eye+dot. 256 (90.7%) of the 282 patients were considered suitable for EES assessment by eye+dot triage. 145 (56.6%) of these 256 patients subsequently received only advice at their EEC visit, suggesting their suitability for community eyecare. 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 patients scheduling in EEC throughout the working week and improve utilisation 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.