Evidence-based management of resident-performed cataract surgery: an investigation of compliance with a preferred practice pattern.

PURPOSE

To evaluate compliance with the American Academy of Ophthalmology (AAO) Cataract in the Adult Eye Preferred Practice Pattern (PPP) in a resident ophthalmology clinic.

DESIGN

Retrospective chart review.

PARTICIPANTS

All patients undergoing first-eye cataract surgery by ophthalmology residents with attending supervision at a Veterans Affairs Medical Center between January 1, 2006, and July 31, 2007.

METHODS

Electronic medical records (EMRs) were reviewed for compliance with the AAO Cataract in the Adult Eye PPP.

MAIN OUTCOME MEASURES

Frequency of resident compliance with all 39 elements of the AAO Cataract in the Adult Eye PPP.

RESULTS

A total of 129 patients met the inclusion criteria. The mean compliance with the PPP was 81%, with 62% of the elements having 90% or greater compliance. Compliance was below the mean for those PPP elements requiring patient input or assessment, including 0% for considering patient preference in the determination of anesthesia management, 73% for patient assessment of preoperative functional status, and 66% for patient assessment of postoperative vision.

CONCLUSIONS

Compliance with the AAO Cataract in the Adult Eye PPP in this resident ophthalmology clinic can be improved by increasing the documentation of patient input about their visual function both preoperatively and postoperatively. Further study of compliance with evidence-based guidelines is needed in ophthalmology, particularly in teaching hospitals where new providers are developing their approach to care.