343 - Improving Evaluation for Failed Vision Screening in Pediatric clinic

Poster Number: 343
Publication Number: 343.345

Yingying Chen, Icahn School of Medicine at Mount Sinai, College Point, NY, United States; Tania C. Lopez, Icahn School of Medicine at Mount Sinai, Queens, NY, United States; Ezoza Akhundjanova, Icahn School of Medicine at Mount Sinai, Astoria, NY, United States; Zoila J. Cano Rodriguez, Icahn School of Medicine at Mount Sinai, Rego Park, NY, United States; Isabella Vallenilla, Icahn School of Medicine at Mount Sinai-Elmhurst, Rego Prk, NY, United States; Ali Abdulkarim, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, United States; Ezequiel Sagray, Elmhurst Hospital Center, Elmhurst, NY, United States; Thaina Rousseau-Pierre, Mount Sinai School of Medicine, Elmhurst, NY, United States; Larissa Polanco, Icahn School of Medicine at Mount Sinai, Bayside, NY, United States

Background: Vision Screening is essential to identify children with potential eye problems and to refer them to a Vision Specialist. Especially during the COVID pandemic when children spent more time with the electronic screen. Untreated eye conditions may lead to vision loss. Making sure children at risk are referred and evaluated by the Vision Specialist will enhance the care of children at risk of vision impairment.

Objective: To increase the percentage of referral given to children aged 3 to 12 who failed the vision screening at health maintenance visits to 100% in a pediatric clinic at a community hospital

Design/Methods: Chart review was done on health maintenance visits for children aged 3 to 12 to assess the percentage of patients referred to a vision specialist when the child fails the screening. Total of 124 patients were included for the baseline assessment over a period of 3 months. We performed 3 PDSA cycles and reviewed 1752 post intervention charts. 338 encounters with failed vision screening. PDSA cycle 1 introduced our project to the providers and an education email sent regarding how to review the vision screening result. For PDSA cycle 2, vision screening result was displayed in the vital sign section of the provider note for easier review of the result. PDSA cycle 3 introduced required documentation of the referral status in the plan section of the provider note when a patient failed the screening. We used a control chart to analyze the progression of the data.

Results: Baseline referral rate for failed vision screening was 50%. After PDSA cycle 1, the referral rate improved to 75%. We realize that the vision screening result was located in a separate section of the patient chart and required some extra steps for the providers to review the result. After PDSA cycle 2, the referral rate improved to 78%. We noticed that some charts were unclear about the referral status in the plan, so we included a required documentation of the referral status in the plan section of the provider note. This last intervention has improved the referral rate to 92%. Data progression has been under control and showed stable progression in the control chart.Conclusion(s): The QI project improved the referral rate for children who failed the vision screening. We anticipate continued improvement with increased provider awareness of the importance of the vision screening. The results are encouraging. We will continue to explore other interventions to eventually reach referral rate of 100%. We also trying to see how routine follow up can be done to assess the status of the evaluation after patients are referred.
Referral rate at the end of each PDSA cycle
Referral rate for Children aged 3 to 12 who Failed Vision Screening