Major Article
The effectiveness of policy changes designed to increase the attendance rate for outpatient retinopathy of prematurity (ROP) screening examinations

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Purpose

To determine the effectiveness of a series of policy changes designed to increase the attendance rate for outpatient retinopathy of prematurity (ROP) screening examinations.

Methods

We retrospectively reviewed the records of consecutive neonatal intensive care unit patients before and after the implementation of policy changes. Policy changes included parent education forms, streamlined scheduling, and creation of a log for all patients seen. The primary outcome measure was attendance rates for the first outpatient appointment after discharge. The Fisher exact test was used to compare rates between the two groups.

Results

Before the policy was implemented, 22 of 52 (42%) neonates and their caregivers attended their first outpatient ROP screening examination on the recommended date. This rate improved significantly after policy implementation, when 46 of 57 (81%) neonates and their caregivers were seen on the recommended date (P < 0.01). The number of patients who ultimately met the criteria for conclusion of acute retinal screening examinations also significantly improved, from 47 of 52 (90%) of neonates in the pre-implementation group to 57 of 57 (100%) in the post-implementation group (P = 0.02).

Conclusions

The attendance rates for initial outpatient ROP examinations and the number of patients who ultimately met criteria for conclusion of acute retinal screening examinations significantly improved after the implementation of new policies.

Section snippets

Methods

This study was approved by the Institutional Review Board of Albany Medical College and conformed to the requirements of the Health Insurance Portability and Accountability Act of 1996. The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement projects were reviewed and applied where possible while we prepared this article.6 The medical records of inpatients screened for ROP at the Albany Medical Center NICU between January 2010 and January 2012 were

Results

A total of 90 consecutive NICU patients met American Academy of Pediatrics screening criteria for ROP before the policies were implemented and 92 consecutive NICU patients met screening criteria after the policies were implemented.1 Of the 90 patients in the pre-implementation group, 38 were excluded from the study: 6 had died, 10 were transferred to another inpatient hospital, 5 were discharged from the NICU before their first ROP screening examination, and 17 completed ROP screening as an

Discussion

The difficulty of transferring care from the inpatient to outpatient setting for premature infants requiring ROP screening has been demonstrated by previous studies and malpractice claims.2, 3, 7, 8, 9 Although differences in methodology make precise comparisons difficult, we believe that the follow-up rates from our pre-implementation group were comparable with results from previously published studies (Table 2).7, 8, 9 The new policies were helpful in improving the ROP follow-up rates at our

Literature Search

A literature search of MEDLINE retrieved 683 articles in English using the search term retinopathy of prematurity follow-up.

Acknowledgments

The authors thank Alicia Quirk, Maureen Devine, Patti Krekeler, Gayle Harshfield, Denise Jones, Ashar Ata, and the staff of the Albany Medical Center NICU.

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Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.