Audit of Waiting Times for Diabetic Laser Treatment

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Audit of Waiting Times for Diabetic Laser
Treatment

• RMK Stewart, S Mahmood, DM Broadbent, SP Harding
• St. Pauls Eye Unit
• Royal Liverpool University Hospital

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Background

• Diabetic retinopathy major cause of visual loss
• Timely laser treatment helps preserve vision
• Laser clinics busy
• Diabetic pts often poor attenders

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Guidelines

• National Service Framework for Diabetes, 2003
• English National Screening Programme for Diabetic
  Retinopathy, 2005
• www.nscretinopathy.org.uk
• Set quality assurance performance indicators for
  maximum waiting times for argon laser treatment

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NSC Service Objectives 11 12

• Proliferative Retinopathy
• Should have 1st PRP treatment

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NSC Service Objectives 11 12

• Maculopathy
• Should have 1st focal/grid laser

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Audit Aims

• Audit current laser treatment waiting times
  against these standards
• Assess if appointment delays from 1st diagnosis
  lead to disease progression
• - PDR with progression to rubeosis or TRD
• - PDR which cannot be lasered due to VH
• - Loss of gt1 line corrected Snellen VA in macular
  oedema

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Methods

• Case note review of all laser clinic appointments
  
• 4 month period 1/10/06 - 31/1/07
• Pt demographics
• Clinic in which listed
• Specific app. date / deadline given
• Waiting times
• Snellen VA at listing and laser
• Disease progression

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Booking System

• Specified date
• Waiting list deadline
• no deadline

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Results

• 1st PRP for PDR from listing n29
• including 3 from screening
• 1st macular laser from listing n37
• including 1 from screening

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NSC Service Objective 11 - PDR

• have 1st PRP treatment lt2 weeks
• Minimum standard 90
• Achievable standard 95

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Waiting Times 1st PRP for PDR
n29
Achieving target lt2 weeks in 9 pts (31)
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NSC Service Objective 11 - Maculopathy

• have 1st focal/grid laser lt10 weeks
• Minimum standard 70
• Achievable standard 95

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Waiting Times 1st Macular Laser
n37
Achieving target lt10 weeks in 31 pts (84)
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Appointment Deadlines

• 16 eyes
• 6 laser NOT within target waiting times
• 2 (13) laser NOT within limits requested
• Neither attributable to DNAs

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NSC Service Objective 12

• From screening have 1st

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Appointments From Diabetic Screening n4
Achieving PRP target lt4 weeks in 0 pts (0) lt6
weeks in 1 pt (33) Achieving macular target lt15
weeks in 1 pt (100)
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Disease Progression Whilst Awaiting Laser

• No record of
• PDR which cannot be lasered due to VH
• PDR with progression to rubeosis or TRD
• Loss gt1 line Snellen VA in macular oedema
• 4 pts (11)
• All treated within 5 wks

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Limitations

• Limited / incomplete cancellation DNA data
• Specified app. / deadline / urgent as per notes
• Severe disease more likely given specified app?

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Conclusions

• St. Pauls failed to achieve 1 of 2 quality
  assurance indicators assessed
• Some correlation with booking process?
• No VH if 1st PRP delayed
• 4 pts lost vision within target waiting time for
  macular laser

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Recommendations

• Increased awareness of guidelines essential
• Tighten procedures to meet the standards
• Refine standards for the future?
• PDR with HRC urgent?
• PDR without HRC longer?
• Maculopathy sooner?
• Audit!

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Thank you