Audit: quality of cataract surgery listing and preoperative assessment documentation

Session Details

Session Title: Presented Poster Session: New & Interesting I

Venue: Poster Village: Pod 3

First Author: : J.Gilmour-White UK

Co Author(s): :    T. Richardson                       

Abstract Details

Purpose:

To evaluate the quality of assessments documented by ophthalmologists listing patients for cataract surgery in clinics and on the day of surgery against standards recommended by the Royal College of Ophthalmology (RCOphth 2010) and the National Institute for Clinical Excellence (NICE 2017).

Setting:

Western Eye Hospital (WEH) an ophthalmology institute in North London, UK that is managed by the Imperial College NHS Trust. This is a multi-subspecialty referral centre in central London with a high volume of cataract surgical referrals.

Methods:

Retrospective audit of 50 assessments documented by ophthalmologists in clinic when listing for cataract surgery and then pre-operatively on the day of surgery. Data was collected from the WEH official electronic medical records platform Medisoft using a pro forma generated from the RCOphth and NICE guidelines. Cases were taken from a variety of Consultant and sub-speciality teams by convenience sampling.

Results:

At listing there was good evidence of: past ocular history (80%), past medical history (80%), drug history (88%), allergies (86%), social history (84%), VA (100%), IOP (96%), cataract examination (94%) and fundus examination (84%). However, there was poor evidence of: assessment of presenting complaint (55%), pupil examination (41%), external eye examination (45%), refractive outcome discussion (41%) and leaflet provision (18%).  There was documentation of pre-operative assessment in 69% of cases. Mostly pre-operative assessment was used only to document risk/benefit discussion (47%) and refractive outcome (59%). The most commonly documented ocular examination feedings where the fundus (18%) and cataract (18%).

Conclusions:

This audit demonstrates potentially significant clinical and ethical-legal risks. The findings were presented locally within ophthalmology speciality teaching and the trust ophthalmology quality improvement meeting. A local standard operating procedure (SOP) for cataract listing and pre-operative assessments will be written. The electronic documentation and listing systems will be optimised to remind and make documentation easy for clinicians. There should also to be an addition of mandatory refractive outcome and risk stratification boxes. A re-audit will be carried out within the next year.

Financial Disclosure:

None