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Nina Marie Farivari, Alain Michael Bauza, Kelly Ma, Amy Hopwood, Mark Houston, Benay Ames, Kelly Castle, Susannah Rowe; Reducing Post-Operative Refractive Surprises in Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6211.
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Refractive outcomes have emerged as a core quality measure for cataract surgery, and one recent report describes the rate of refractive surprise following cataract surgery in a large academic institution. While certain patient characteristics predict higher rates of refractive surprise, the aggregate rate of refractive surprises within an organization also can be viewed as systems issue that is potentially amenable to quality improvement initiatives. The goal of this quality improvement project was to improve the refractive outcomes of cataract surgery through a series of process interventions within the Ophthalmology Department at the Boston University School of Medicine and Boston Medical Center (BU/BMC). <br />
Using billing data, we identified all cataract surgeries performed at BU/BMC between July 1, 2013 and June 30, 2014. Patients with comorbidities known to affect refractive outcomes and those without post-operative data were excluded. We determined the baseline rate of refractive surprise by comparing the postoperative refraction in spherical equivalents to the preoperative target refraction for each patient. A multidisciplinary team of technicians, administrators and surgeons developed a process map detailing the relevant processes between booking surgery and IOL implantation. The team then defined best practices for each step, and identified key opportunities for reducing variability in practices. A total of 8 interventions were implemented in rapid succession over the course of the year, primarily involving technician training and performance standards. The rate of refractive error was tracked over time to assessing for improvements following interventions.
818 cataract surgeries were performed at BU/BMC between July 1, 2013 and June 30, 2014. Of these, 749 met inclusion criteria. Following process improvements, the likelihood of achieving a refractive outcome within +/- 0.5D of target refraction improved from 64% in the first quarter to 76% in the final quarter. The likelihood of achieving a refractive outcome within +/- 1.0D of target refraction improved from 89% in the first quarter to 95% in the final quarter.
This project demonstrates the impact of a systems-based approach to improving refractive outcomes of cataract surgery at a major teaching hospital, and suggests that modifying processes to adhere to best practices and reduce variation can lead to improved refractive outcomes.
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