Patient Care Spotlight: Trauma and Consult Service

Tucked away in a hallway behind the busy emergency room and trauma center at Harborview Medical Center is a small exam room dedicated to urgent ophthalmology cases.

The Department of Ophthalmology handles about 1,500 emergency room visits a year. It is one of the few ERs to have dedicated ophthalmology space within the ER.

“We are delighted to have this space. We used to haul the equipment around the emergency department or bring patients to the clinic,” said Dr. Jennifer Yu, MD, PhD, Clinical Associate Professor and director of the Trauma and Consult Service at Harborview and the 4-West Ophthalmology Clinic.

The ER exam room was recently upgraded with a new ultrasound device, a YAG laser, and a combined fundus camera/OCT machine with robotic capability.

Patients are triaged through the ER and sent to ophthalmology for a variety of concerns. These include traumatic globe injuries, lacerations to the eyelid, removal of foreign bodies in the cornea, infections, and retinal detachments.

“We see pretty much everything in this room,” Dr. Yu said. “The volumes have grown each year.”

Often, the patients are referred to the Harborview ER from community physicians or hospitals that may not have an ophthalmology service. Furthermore, Harborview is the region's only level 1 trauma center, handling the most severe trauma cases in a five-state area.

During the day, a resident consults with emergency patients and those in the hospital. After hours, the on-call resident handles emergencies.

“They typically see between three and eight patients daily through the ER. They also go see patients on the floor, as most of them aren’t able to go to clinic for their examination, so we go to them with our portable equipment,” Dr. Yu said. “There can be as many as 10-13 inpatient checks each day, and many of them need to be seen repeatedly during their hospital stay.’

Marcus Turner, MD, a second-year resident, recently completed his five-week rotation as the consult resident.

“This is a busy level 1 trauma center, and the sheer volume of what I see, doing procedures, managing complex cases, working with different attending physicians, has been a tremendous learning experience for me,” Dr. Turner said.

Dr. Yu said patients who come through the ophthalmology ER are stabilized and hospitalized if needed. Many are referred to 4-West, the Harborview ophthalmology clinic, and the Eye Institute for follow-up care.

“Often the patients we see don’t have anywhere else to go,” Dr. Yu said. “The culture at Harborview is to support that patient. It's a gratifying part of being here.”