3 years ago

Optimizing preoperative requirements for outpatient cataract surgery at the Royal Alexandra Hospital

Hermina Strungaru, Nichole Pereira, Hilary Salmonson, Haily Nguyen, Christopher J. Rudnisky, Keith Drader, Karen Harris, Karim F. Damji

Publication date: Available online 19 October 2018

Source: Canadian Journal of Ophthalmology

Author(s): Hermina Strungaru, Nichole Pereira, Hilary Salmonson, Haily Nguyen, Christopher J. Rudnisky, Keith Drader, Karen Harris, Karim F. Damji

Abstract
Objective

To evaluate preoperative testing for cataract surgery, implement stakeholder-driven change, and increase the number of patients who arrived for surgery with complete preoperative requirements, for the purpose of delivering safe, high-quality, and cost-effective care for patients.

Design

Quality improvement.

Participants

Cataract surgery patients, health care staff in Ophthalmology Day Surgery, an Ophthalmology improvement team, the Clinical Section Heads of Ophthalmology and Anaesthesia, Quality Consultants, and members of the Quality Council participated in this study.

Methods

A lean quality improvement approach was used to define and build understanding of the problem. Between July and November 2016, a chart-based reporting system captured all patients who arrived for cataract surgery with expired or incomplete preoperative requirements. A cost analysis was completed, and evidence was reviewed to ensure alignment with best practice preoperative recommendations.

Results

On average, 25% (619/2451 over a 17-week period) of patients per day arrived at the Ophthalmology Day Surgery for cataract surgery with incomplete and/or expired physical history forms and ECGs. An improvement team worked to implement a radical improvement idea and relied on an existing questionnaire to ensure patient safety preoperatively.

Conclusions

Based on the literature, best practice guidelines, and a cost analysis, it was decided that patients undergoing routine cataract surgery in Edmonton Zone Hospitals under regional anaesthesia would no longer require physician history and physicals and ECGs. Elimination of the preoperative requirements for all but select high-risk patients meant that 100% of patients who arrived for cataract surgery would not have outstanding presurgery requirements.

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