Emergency Department

I. Department History The primary functions of the Emergency Department are to provide resuscitation, differential diagnosis, emergency management, and surgery for emergency patients presenting to the hospital and patients from outside the hospital, ensuring that patients receive timely, professional, and scientifically based treatment when they suffer sudden illness or accidental injury. The department’s treatment scope includes all types of ocular trauma: penetrating injury of the eyeball, globe rupture, ocular contusion, perforating injury of the eyeball, ocular chemical burns, intraocular foreign bodies, and endophthalmitis. It is also the hospital’s department for the diagnosis and treatment of general ophthalmic diseases, providing care for patients who present routinely. The Emergency Department primarily performs cataract surgery, glaucoma surgery, combined cataract and glaucoma surgery, surgery for lens dislocation, corneal disease surgery, surgery and treatment for trauma-related eye diseases, retinal detachment surgery, surgery for diabetic retinopathy, and surgery for macular diseases. The predecessor of the Emergency Department was the Department of Ocular Trauma. Its former department head was Associate Chief Physician Tang Yong, and its current department head is Chief Physician Kong Yichun. II. Main Timeline, Highlights, and Important Work In 1958, Wu Guifang transferred to Tianjin Municipal Eye Hospital and began treating ocular trauma, including ocular wound repair, removal of magnetic foreign bodies from the crystalline lens, removal of nonmagnetic intraocular foreign bodies, urokinase irrigation for hyphema, ciliary body suturing, treatment of traumatic hypotony, and other procedures. In particular, for conditions such as traumatic hyphema and vitreous hemorrhage, a set of treatment protocols was developed that solved the problem of secondary hemorrhage in trauma patients, achieving results that were at the national forefront. In the same year, Tianjin Municipal Eye Hospital became one of the first institutions in China to divide general ophthalmology into subspecialties, including ophthalmic muscles, glaucoma, ocular trauma, external eye diseases, fundus diseases, retinal detachment, and traditional Chinese ophthalmology. On April 1, 1997, the Emergency Eye Disease Center of Tianjin Eye Hospital officially began providing services. In July 2022, in response to the national strategic call to “strengthen emergency services and keep green channels open,” the hospital leadership decided, after discussion, to separate emergency work from the Department of Ocular Trauma and establish an emergency ward, so that emergency patients could be diagnosed and treated in a more focused, rapid, and efficient manner. The main highlights of the work of the Ophthalmic Emergency Department include the following: 1. Emergency work during a special period: When the emergency ward was first established, the country was in a period of strict prevention and control of the COVID-19 pandemic. All patients were required to have a negative COVID-19 nucleic acid test report before they could be admitted for surgery. This was a major difficulty for emergency patients who needed surgery as soon as possible, and an equally major challenge for emergency physicians. Through summarizing our experience, we developed a set of diagnostic and treatment procedures: when patients presented to the outpatient and emergency clinic, the receiving physician first assessed their condition. For patients who might require inpatient surgery, they were first instructed to go to a nearby general hospital capable of screening for COVID-19 nucleic acid around the clock, after which subsequent examinations and inpatient admission procedures were completed. This greatly shortened the preoperative waiting time for emergency patients. For critically ill patients who needed to be admitted for surgery as soon as possible, we communicated in advance with ward nursing staff, relevant operating-room personnel, property-management and logistics staff, and others. After ensuring adequate protective measures, we cleared the route in advance, transported the patient to the isolation ward via a dedicated elevator, completed the preoperative preparations, and then transported the patient to the operating room via a dedicated elevator. Logistics support personnel carried out disinfection along the route. The operating surgeons, meanwhile, had to put on airtight protective clothing in accordance with pandemic prevention and control requirements and perform surgery fully equipped with protective gear, which greatly increased the difficulty of the operation. 2. Improving the handover system: A work group for emergency physicians was established. For patients requiring special attention, the receiving physician issues an early warning in the work group so that the physician taking over the shift is fully informed and potential medical safety risks can be prevented before they occur. 3. Improving the patient-tracking system: For emergency patients requiring hospitalization, the receiving physician sends the patient’s information to the work group so that the ward physician on duty can understand the patient’s condition at the earliest opportunity, contact ward nursing staff and relevant operating-room personnel in advance, complete the preoperative preparations as soon as possible, and arrange surgery. This shortens the patient’s preoperative waiting time and improves patient satisfaction with care. 4. Improving the patient reception and referral systems: For patients presenting to the hospital, a standardized outpatient medical record must be written regardless of whether they have registered. For patients who need to be referred to the outpatient operating room or the outpatient clinic of another department, attention should be paid to wording when explaining the condition, leaving room for the collaborating department and ensuring that the entire hospital works as one coordinated whole, thereby reducing the incidence of medical disputes and complaints. 5. Improving the stepwise reporting system: For patients requiring emergency admission, the receiving physician should consult the ward physician on duty in advance and strictly control the indications for emergency admission in accordance with hospital regulations. If the physician on duty is unable to make a decision, the matter should be further reported to the head of the Emergency Department for a final determination. 6. Improving the daytime emergency physicians’ meal system: After completing the diagnosis and treatment of morning patients, daytime emergency physicians eat in the consultation room. During this period, patient-guidance staff are responsible for guiding and explaining matters to patients arriving for afternoon care in order to reduce related complaints. Trauma patients and patients with special circumstances do not need to wait and may receive priority care. 7. Improving the surgical case-review system: The physician on duty must record emergency surgeries on video. The head of the Emergency Department conducts regular one-on-one reviews and provides suggestions for improvement regarding deficiencies, thereby raising the overall surgical proficiency of the hospital’s physicians on duty. The main priorities of the work of the Ophthalmic Emergency Department include the following: 1. Rapid and accurate diagnosis: Ophthalmic emergency physicians need extensive experience and skills in order to rapidly and accurately diagnose various eye diseases and emergencies. This includes rapidly analyzing ocular symptoms, signs, and examination results, and performing emergency surgery or intervention when necessary. 2. Providing emergency treatment: One of the main responsibilities of the Ophthalmic Emergency Department is to treat patients with eye diseases requiring urgent care. This may include medication, debridement and suturing, vitrectomy, and other surgeries, as well as other necessary emergency measures. 3. Coordinating multidisciplinary collaboration: Ophthalmic emergency physicians need to work closely with multiple departments to provide patients with comprehensive treatment. This includes collaboration with other ophthalmic subspecialties, general practitioners, neurologists, otolaryngologists, and others in order to provide patients with the best treatment plan. 4. Focusing on patient comfort and psychological support: Eye diseases often cause patients considerable discomfort and anxiety. Ophthalmic emergency physicians need to pay attention to patients’ comfort, provide psychological support, and ensure that patients feel safe and comfortable throughout treatment. 5. Conducting clinical research: Ophthalmic emergency physicians also need to follow the latest clinical research and technological advances in order to continuously improve their diagnostic and treatment capabilities and promote the development of the specialty. In summary, the focus of ophthalmic emergency work is the rapid and accurate diagnosis and treatment of eye diseases, the provision of comprehensive services and care for patients, and close collaboration with multiple specialties to improve overall treatment outcomes. The Emergency Department has physicians on duty 24 hours a day, safeguarding patients’ eye health in every respect.