|Assessing the Degree of Pain Associated with Intravitreal Injections
||In this practice, internal guidelines called for patients to be brought into the treatment room for an intravitreal injection within 5-20 minutes following instillation of 2% Lidocaine gel. However, compliance with this guideline was only at 64%. After implementing steps to streamline processes, 94% of patients were treated within these guidelines. In addition, patients’ average pain index score decreased from 1.12 to 0.5 after the project’s interventions.
||Process of care
Less variation Patient outcomes
|Critical Problem Areas in Patient Safety and Education in Age-Related Macular Degeneration
||This project sought to define a comprehensive strategy for specific and appropriate patient education measures regarding the prevention of progressive vision loss and new onset of vision loss, along with safety measures to minimize unnecessary vision loss. Among the project’s outcomes was that all but one patient in the study experienced an improvement in visual acuity.
|Improving Effectiveness of Treatment of Patients with Diabetic Macular Edema
||Diabetes is an increasingly common, systemic disease often complicated by sight-threatening visual loss resulting from diabetic macular edema. Successful treatment can be slow and difficult, involving numerous visits and very expensive drugs. The aim of this project was to leverage resources to achieve improved eye health in patients with diabetic macular edema. Patients in this study experienced a greater rate of decrease in both blood sugar and systolic blood pressure following project implementation.
|Improving Counseling and Compliance for Patients with Use of AREDS in Advanced AMD
||The project’s goal was to use data to increase the number of patients with advanced AMD taking AREDS. Initially, about half of patients were not taking AREDS. Following the plan’s interventions, which included a systematic patient outreach plan, 57% of patients who were counseled to take AREDS began to take AREDS within a 90-day follow-up period. The majority of patients who reported not taking AREDS in the 90-day follow-up period agreed to start taking AREDS as soon as possible.
Compliance Practice Improvement Counseling
|Improving Amblyopia Compliance in Children
||This project examined compliance with patch therapy in pediatric patients. Interventions included enhanced patient education techniques and counseling. By the project's conclusion, patch compliance in 30 patients improved from 81% to 94%. The project helped staff learn what motivates families to patch and inspired the care team to more dilligently recommend correction of patient amblyopia.
|Improving Rate of Gonioscopy Performed on Glaucoma Patients
||About 33% of patients presenting for glaucoma evaluation were receiving goniosopic evaluations. Gonioscopes were falling through the cracks, perhaps because patients were dilated prior to being identified as glaucoma suspects or having POAG. Implentation of a reference chart to ensure that the diagnostic tests were performed resulted in improved quality of care, with 97% of subsequent patients receiving a gonioscopy evaluation.
|Reducing Extraneous OCT and VF Testing of Plaquenil Patients
||This project aimed to decrease extraneous testing in order to reduce risk to patients and conserve organizational resources. Following interventions, there was a 12.9% reduction in superfluous testing when all "Plaquenil patients" presenting to the clinic were examined. Given that prior to the intervention 100% of all Plaquenil patients were subjected to testing, the project had a significant and positive impact on patient safety as well as patient and healthcare facility time, energy, and money.
Visual field testing
Inverse process measure
|Reducing Incidence of Post-Intravitreal Injection Corneal Abrasion
||This project was designed to reduce the frequency of post-intravitreal injection corneal abrasions. The estimated risk of corneal abrasion in two large studies of intravitreal injections is roughly 0.15% (1 in 750). After making changes in the intravitreal injection procedure (provider/staff/equipment) over three months, the incidence of corneal abrasions after intravitreal injections at the clinic was dramatically reduced from 1 in 50 (2%) to 1 in 200 (0.5%).
|Reducing Rate of Perioperative Incidents Related to Intraoperative Time-Out Procedure
||To improve quality outcomes and create a safer medical practice environment for patients, this project addressed perioperative incidents related to gaps in the process of conducting sign-in/time-out for surgical vitreoretinal procedures. Following systematic changes to the sign-in/time-out processes, none of the 126 patients in the follow-up study groups experienced perioperative incidents. The surgical team plans to adopt these new processes as a “lifetime” project.
Air embolus during vitrectomy
LASIK flap damage
Surgical consent error
Surgical practice improvement
|Reliability of Neuroimaging Studies
||Patients are seen for a variety of neuro-ophthalmic disorders and undergo neuroimaging. These scans are often interpreted by general radiologists without specific neuro-radiologic training. This project reviewed 54 neuroimaging studies by neuroradiologists at an academic medical center to see if any abnormalities were overlooked and/or misinterpreted, and if so, whether it altered the diagnosis and management of the patient. In 12/54 of cases, new or re-interpreted findings emerged which led to a change in diagnosis or patient management in 75% of those instances.
|Unilateral Ptosis Repair
||To improve Margin to Reflex 1 (MRD-1) symmetry in unilateral ptosis patients, this project incorporated Hering's Law testing in the preoperative assessment. Pre-intervention analysis of 40 unilateral ptosis patients revealed postoperative MRD-1 asymmetry to be 0.96 mm. Incorporating the Hering's Law test improved postoperative MRD-1 symmetry to an average of 0.48 mm over 40 unilateral ptosis patients, which was a 50% improvement.
Margin to Reflex