Earl K. Long Medical Center Diabetic Retinal Eye

Screening Mary Campos RN, CDE

Diabetes Care Manager

January 25, 2011

EKL MC Site visit October 2007

But Dr. Butler, even though our eye screens are low, we have data to prove that they are being ordered.

I don’t care how you get them done, just get them done even if you have to purchase a retinal camera!

Committee Members

Diabetes Team Lead- Endocrinologist

Chief of Ophthalmology Retina Specialist Disease Management Supervisor Diabetes Care Manager Clinic Nurse Managers LPN-Retinal Eye Technician

Other Services

Computer Services Diabetes Clinic Administrative

Assistant Financial Management Analyst Maintenance Department Ophthalmology Clinic Staff Resource Scheduling Supervisor Runner/Transporter Screening Department

Determine Roadblocks Data Collection:

Is it a referral problem?≈80% referred- < 50% scheduled

Is it an access to service issue?Ophthalmology Clinic: 17 wks booked

Waiting list: 478 patients

Scope of the Problem Below ADA standards at achieving

diabetic retinal eye screens

Scope of the Problem

Lack of Access into Ophthalmology

Clinic

Formulate Plan of Action

Develop a “One Stop Shop” Program Observe a Model Program (UMC) Partner with the Ophthalmology

service Get approval from administration

Short Term Goals Improve access into the

Ophthalmology Clinic by eliminating the waiting list

Improve quality of care by increasing access into the

Ophthalmology Clinic

Meet HCSD system benchmark in performing yearly retinal eye exams by increasing screens through

retinal photography

Long Term Goal

To meet or exceed ADA standards in order to improve patient outcomes

Population Served

Any ambulatory person with Diabetes last retinal exam one year or

greater no past history of treatable eye

disease

Expenses One FTE (LPN) Topcon Non Mydriatic Retinal

Camera Non Contact Computerized

Tonometer power tables included

Warranty, installation, and in-service $95.00

$22,895

$7,695

Implement the Plan

Strategically located the clinic; Hired staff; Purchased equipment; Created a system for walk in; Educated staff on the referral

process; and Opened business

Process Phase 1:

Walk-in Family Practice Clinic only

Phase 2: Opened 4 slots a day for booked

appts.- later changed to 12 slotsscheduled from waiting listrescheduled routine Ophthalmology appts. into Screening Clinic

Process Phase 3: Opened to other clinics

Diabetes and Diet Clinic Foot, Wound, and EIC NBR and SBR Clinics

Phase 4: Opened to remaining clinics Medicine and SP Clinics

Procedure Patient checks in and attended Reports to the Screener

Visual Acuity Test Tonometer Test to evaluate IOP Retinal Photography- 4 views in

each eye

Procedure

After the exam, the screener: Records a brief history, visual

acuity, and IOP results Places form in a folder for pick up

Runner transports documentation forms “weekly” to the Ophthalmology Clinic

To be reviewed

Procedure

Ophthalmologist: Reads photos via computer Records findings and

recommendations Schedules Ophthalmology appt if

needed

Runner returns forms to screenerReviewed

Procedure

Screener: Inputs information into the data

base Files forms into the medical record

Program Evaluation

Screening time from check in to departure Initially : 15-32 minute average After first month: 9-19 min After 6 months: 8-9 minutes

Retinal Eye Screen Clinic

Retinal photography opened December 2009

On-site Clinics

Family Practice

Diabetes & Diet

Foot & Wound

EIC CL

Off-site Clinics

NBR & SBR

Specialty

Medicine

Ophthalmology

Referral Source

579

116 71 50 600

200

400

600

800

FP/NBR MED/SP Diabetes SBR Other

# Ref

erre

d

“One Stop Shop” Majority of referrals came from

clinics located within the same building (Jan-June data)

Total Screens Performed

Retinal Eye Screens performed from Jan - Sept 2010

1220

373

0

500

1000

1500

Total Screened Ophthalmology f/u required

To

tal #

pat

ien

ts

1220 within the first nine months “69%” screen only “31%” Ophthalmology follow up

needed

Program Evaluation: Goal # 1

Improve access into the Ophthalmology

Clinic by eliminating the waiting list Goal met within 4 months Ophthalmology Waiting List

478

248

00

200

400

600

Jun-09 Feb-10 April-Sept2010

month/year

# p

ts. w

ait

ing

Jun-09

Feb-10

April-Sept 2010

Program Evaluation: Goal # 2

Improve quality of care by increasing access into the Ophthalmology Clinic Goal met within 6 months

Ophthamology Clinic Access 17

8

14

2 3

0

5

10

15

20

Month / Year

Wee

ks B

oo

ked

Program Evaluation: Goal # 3

Exceed HCSD system average of 43.6% Goal met for the last 3 quarters

Improvement over Time

Award criteria met

Eye Screen Improvement over Time

0

10

20

3040

50

60

70

Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11

Quarter Comparison

Per

cent

Scr

eene

d

Q1 09

Q2 09

Q3 09

Q4 09

Q1 10

Q2 10

Q3 10

Q4 10

Q1 11

Program Evaluation: Long Term Goal

Achieve ADA standard at obtaining yearly retinal eye screens of 61% Approaching goal

ADA's Benchmark (61%)

51.7

58.8

55.6

47

4951

53

55

5759

61

Q3 10 Q4 10 Q1 11

Last 3 Quarter results

Pe

rce

nt

Ac

hie

ve

d

Other Benefits of the Program

Early detection and treatment Frees up Ophthalmologist

Walk in availability Addresses transportation and

scheduling issues Quick procedure

Non dilated exam (no driver needed)

Academic benefits

Ophthalmologist Feedback

Very happy with the success of the program

Quality photos being received Able to address diabetic retinopathy

and other issues more rapidly

Opportunities for Improvement

Cliq input of retinal screen (accomplished in September)

Electronic Medical Records Develop a system for pt feedback

regarding results

Keys to our Success Collaborative support from the UMC

staff “One Stop Shop” Clinic location Partnership with our Ophthalmology

Program Multi-disciplinary team work

Purr………..Now… that’s better!

Six months after instituting the Retinal Eye Screen Program