An Eye on Efficiency: A Quality Improvement Project to Increase Ophthalmology Equipment in the Accident and Emergency Department.

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.