Developing a quality assurance framework for neuro-ophthalmology referrals using NODE - the Neuro-ophthalmology database.

Abstract

Purpose : Quality assurance (QA) in neuro-ophthalmology (NOPH) is often lacking. The QA registry, NODE (Neuro-ophthalmology Database), was established and implemented in tertiary NOPH clinics in Australia. We developed a consensus on triage categories according to Australian standardised triage categories; P1 (consult<= 30 days), P2 (consult<= 30 to 60 days) and P3 (consult>60 days). Triage categories and time-to-consult for common NOPH conditions were compared to evaluate quality of referral assessment at a single site.

Methods : We collected data in NODE on 410 patients at Alfred Hospital, Melbourne. We developed a consensus on assignation of NOPH conditions to triage categories using recommendations from a panel of seven experienced neuro-ophthalmologists. Panelists scored conditions and triage categories using a modified Delphi approach (strongly agree, agree, neutral, disagree or strongly disagree). Consensus was considered when ≥75% of the panel strongly agreed or agreed. We analysed the mean days from referral to triage, and, from triage to the initial consultation, and compared that to the developed triage category standard.

Results : Most patients presenting to the service were female (n=262, 64%), aged 21 to 30 years. Common diagnoses were Idiopathic Intracranial Hypertension, IIH (24%), Optic Neuropathy, ON (17%), Headaches, (11%) Cranial Nerve Defects, CND (9%) and Eye Movement Disorders, EOMD (9%). Consensus on triage category assignment was reached after 1 round of scoring from expert panel members. The mean time from referral to triage was performed in <2 days for all the common diagnosis at the NOPH clinic. The mean time (days, +-standard deviation (SD)) from P1 category triage to initial consult for IIH was 26 (±7), ON 27 (±11), and CND was 17 (± 5). The mean time (days) from P2 triage to initial consultant for Headaches was 27 (±12), and EOMD was (±17). The mean time (days) from P3 triage to initial consultant for Myasthenia Gravis was 30 (±10).

Conclusions : We have established a consensus agreement on triage categories for neuro-ophthalmological conditions. Further validation using a larger panel of experts would be able to refine this further. Data from NODE demonstrated that most conditions are appropriately triaged and seen. We established a QA framework for other NOPH clinics in Australia.

This is a 2021 ARVO Annual Meeting abstract.