Earl K. Long Medical Center Diabetic Retinal Eye Screening

1. Earl K. Long Medical CenterDiabetic Retinal Eye Screening Mary Campos RN, CDE Diabetes Care Manager January 25, 2011

2. 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! EKL MC Site visit October 2007

3. Committee Members • Diabetes Team Lead- Endocrinologist • Chief of Ophthalmology • Retina Specialist • Disease Management Supervisor • Diabetes Care Manager • Clinic Nurse Managers • LPN-Retinal Eye Technician

4. Other Services • Computer Services • Diabetes Clinic Administrative Assistant • Financial Management Analyst • Maintenance Department • Ophthalmology Clinic Staff • Resource Scheduling Supervisor • Runner/Transporter • Screening Department

5. 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

6. Scope of the Problem • Below ADA standards at achieving diabetic retinal eye screens

7. Scope of the Problem • Lack of Access into Ophthalmology Clinic

8. Formulate Plan of Action • Develop a “One Stop Shop” Program • Observe a Model Program (UMC) • Partner with the Ophthalmology service • Get approval from administration

9. 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 screensthrough retinal photography

10. Long Term Goal • To meet or exceed ADA standards in order to improve patient outcomes

11. Population Served • Any ambulatory person with Diabetes • last retinal exam one year or greater • no past history of treatable eye disease

12. 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

13. 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

14. Process • Phase 1: • Walk-in Family Practice Clinic only • Phase 2: • Opened 4 slots a day for booked appts.- later changed to 12 slots • scheduled from waiting list • rescheduled routine Ophthalmology appts. into Screening Clinic

15. 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

16. 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

17. 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

18. Procedure • Ophthalmologist: • Reads photos via computer • Records findings and recommendations • Schedules Ophthalmology appt if needed • Runner returns forms to screener Reviewed

19. Procedure • Screener: • Inputs information into the data base • Files forms into the medical record

20. 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

21. Retinal Eye Screen Clinic • Retinal photography • opened December 2009 Mid City Clinic

22. Referral Source • “One Stop Shop” • Majority of referrals came from clinics located within the same building (Jan-Junedata)

23. Total Screens Performed • 1220 within the first nine months • “69%” screen only • “31%” Ophthalmology follow up needed

24. Program Evaluation: Goal # 1 • Improve access into the Ophthalmology Clinic by eliminating the waiting list • Goal met within 4 months

25. Program Evaluation: Goal # 2 • Improve quality of care by increasing access into the Ophthalmology Clinic • Goal met within 6 months

26. Program Evaluation: Goal # 3 • Exceed HCSD system average of 43.6% • Goal met for the last 3 quarters

27. Improvement over Time • Award criteria met

28. Program Evaluation: Long Term Goal • Achieve ADA standard at obtaining yearly retinal eye screens of 61% • Approaching goal

29. 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

30. Ophthalmologist Feedback • Very happy with the success of the program • Quality photos being received • Able to address diabetic retinopathy and other issues more rapidly

31. Opportunities for Improvement • Cliq input of retinal screen (accomplished in September) • Electronic Medical Records • Develop a system for pt feedback regarding results

32. Keys to our Success • Collaborative support from the UMC staff • “One Stop Shop” • Clinic location • Partnership with our Ophthalmology Program • Multi-disciplinary team work

33. Purr……….. Now… that’s better! Six months after instituting the Retinal Eye Screen Program