le Roux Jacques, Gupta Ayushi, Govender Jaykumaran
Emergency Medicine, Whittington Health NHS Trust, London, GBR.
Ophthalmology, Royal Free Hospital, London, GBR.
Cureus. 2024 Dec 19;16(12):e76032. doi: 10.7759/cureus.76032. eCollection 2024 Dec.
Introduction Ophthalmology presentations contribute significantly to Accident and Emergency (A&E) attendance. The provision of safe care depends on clinical skills and appropriate equipment. This quality improvement project aimed to increase the availability of ophthalmoscopes and Snellen charts required for a basic ophthalmological assessment in an A&E department in North London. Methods The time taken for 23 permanent staff to retrieve a working ophthalmoscope and 9 permanent staff to find a Snellen chart, respectively, were recorded in different areas of the department. Following this, broken ophthalmoscopes were replaced, and additional ophthalmoscopes and Snellen charts were installed. The task was repeated post-intervention. Results Pre-intervention, there was 1 ophthalmoscope per 4.9 cubicles which increased to 1 per 1.7 cubicles post-intervention. The number of ophthalmoscopes in paediatric A&E and the number of mobile ophthalmoscopes increased the most. The median time taken to find a working ophthalmoscope anywhere in the department was 53 seconds pre-intervention and 19 seconds post-intervention. The median time taken to find a Snellen chart was 90 seconds pre-intervention and 32 seconds post intervention. Conclusions This quality improvement project successfully increased the number of ophthalmoscopes available in the department to meet local targets in most areas of A&E except for the major injuries and resuscitation areas. The time taken to find a working ophthalmoscope and Snellen chart was significantly reduced. Based on the number of patients presenting to our A&E with eye complaints over a one-year period between 01/07/23 and 01/07/24, these interventions will save approximately 13.6 clinician working hours searching for an ophthalmoscope and 15.4 clinician working hours searching for a Snellen chart.
眼科疾病表现导致大量患者前往急诊室就诊。提供安全的护理依赖于临床技能和合适的设备。本质量改进项目旨在增加伦敦北部一家急诊部门进行基本眼科评估所需的检眼镜和斯内伦视力表的数量。方法：记录了23名固定工作人员在科室不同区域找到一台可用检眼镜所需的时间，以及9名固定工作人员找到一张斯内伦视力表所需的时间。在此之后，更换了损坏的检眼镜，并安装了额外的检眼镜和斯内伦视力表。干预后重复此项任务。结果：干预前，每4.9个隔间有1台检眼镜，干预后增至每1.7个隔间有1台。儿科急诊室的检眼镜数量和移动检眼镜数量增加最多。在科室任何地方找到一台可用检眼镜的中位时间，干预前为53秒，干预后为19秒。找到一张斯内伦视力表的中位时间，干预前为90秒，干预后为32秒。结论：本质量改进项目成功增加了科室可用检眼镜的数量，以满足急诊室大多数区域的本地目标，但重伤和复苏区域除外。找到可用检眼镜和斯内伦视力表所需时间显著减少。根据2023年7月1日至2024年7月1日这一年期间到我们急诊室就诊且有眼部不适的患者数量，这些干预措施将节省约13.6个临床医生寻找检眼镜的工作小时数和15.4个临床医生寻找斯内伦视力表的工作小时数。
