Improving examination documentation practices for ocular trauma in the ophthalmic emergency department

Ansa Anam; Imran Ahmad; Fahd Zafar Khan; Asna Tahir; Ammara Sadiq

Author(s)

Ansa Anam Department of Ophthalmology, Khyber Teaching Hospital,Peshawar -,Pakistan

Imran Ahmad Department of Ophthalmology, Khyber Teaching Hospital,Peshawar -,Pakistan

Fahd Zafar Khan Department of Ophthalmology, Khyber Teaching Hospital,Peshawar -,Pakistan

Asna Tahir Department of Ophthalmology, Khyber Teaching Hospital,Peshawar -,Pakistan

Ammara Sadiq Department of Ophthalmology, Khyber Teaching Hospital,Peshawar -,Pakistan

Abstract

Objective: To assess and improve the documentation of ocular trauma examinations in an ophthalmology emergency department through the implementation of a structured proforma and focused training. Methodology: This quality improvement project (QIP) was conducted in two 30-day cycles at the Ophthalmology Department of MTI-Khyber Teaching Hospital, Peshawar following the Plan-Do-Study-Act (PDSA) methodology. The first cycle assessed baseline documentation compliance for six key parameters in ocular trauma examinations. A newly structured proforma and training intervention were then introduced. The impact of these interventions on documentation practices was assessed in the second cycle. Results: Initial compliance rates were low for visual acuity (66.66%), extraocular movements (70.8%), visual fields (0%), and ocular diagrams (33.33%). Post-intervention, significant improvements were observed across all parameters: visual acuity (91.66%), extra-ocular movements (95.83%), visual fields (83.33%), and ocular diagrams (87.5%). Statistically significant improvements were seen in all four parameters (p<0.05) using Paired samples t-tests. Conclusion: Implementation of a structured proforma and targeted training significantly enhanced the docu-mentation of ocular trauma examinations. This QIP demonstrates the effectiveness of simple interventions in enhancing documentation practices, potentially lead-ing to improved patient care in ophthalmology emer-gency departments.

Publication Details

Page(s) 475-478

DOI DOI not available

Published Journal: Rawal Medical Journal, Volume: 50, Issue: 2, Year: 2025

Request the full text from PASTIC

Keywords

Emergency department., Documentation, Ocular Trauma, Quality improvement

References

Jeffery Heath,Dobes RC,Chen J,FK J .2022 .Eye injuries: understanding ocular trauma. Aust J Gen Pract, 51 : 476-82.

Zeeshan MLABA,Karamat JB .2019 .Frequency and characteristics of ocular trauma in a tertiary care hospital in Lodhran. Pak J Ophthalmol, 34 : 116-21.

Duan F,Chen X,Zhang S,Qi X,Shi W,Gao H. .2020 .Clinical characteristics, and visual outcomes of patients hospitalized for ocular trauma in Shandong Province, China. J Ophthalmol, : 1-5.

Negrel A .1997 .Magnitude of eye injuries worldwide. CEHJ, 10 : 49-53.

Hill SC,Dennick R,Amoaku WM .2017 .Present, and future of the undergraduate ophthalmology curriculum: a survey of UK medical schools. Int J Med Educ, 8 : 389-95.

. .Eye emergency manual: An illustrated guide. 2nd ed. New South Wales Ophthalmology services: Emergency Care Institute New South Wales; 2009. Chapter, 2 : 33-34.

Sanders DS,Lattin DJ,Read-Brown S,Tu DC,Wilson DJ,Hwang TS .2013 .Electronic health record systems in ophthalmology: impact on clinical documentation. Ophthalmology, 120 : 1745-55.

Chiang MF,Read-Brown S,Tu DC,Choi D,Sanders DS,Hwang TS .2013 .Evaluation of electronic health record implementation in ophthalmology at an academic medical center (an American Ophthalmological Society thesis. Trans Am Ophthalmol Soc, 111 : 70-92.

Sanders DS,Read-Brown S,Tu DC,Lambert WE,Choi D,Almario BM .2014 .Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing. JAMA Ophthalmol, 132 : 586-92.

Tahim AS,Bryant C,Greaney L,Rashid A,Fan K. .2013 .Improving documentation of visual acuity in patients suffering facial fractures. Emerg Med J, 30 : 949-50.

Sharma P,Sharma R .2007 .Medical case note-keeping & documentation practices. Internet J Healthcare Administr, 5 : 723-30.

Agarwal R,Rao G,Naigaonkar R,Ou X,Desai S. .2011 .Prognostic factors for vision outcome after surgical repair of open globe injuries. Indian J Ophthalmol, 59 : 465-70.

Jahangir T,Butt NH,Hamza U,Tayyab H,Jahangir S H .2011 .Pattern of presentation and factors leading to ocular trauma. Pak J Ophthalmol, 27 : 96-102.

Babar TF,Khan MT,Marwat MZ,Shah SA,Murad Y,Khan MD .2007 .Patterns of ocular trauma. J Coll Physicians Surg Pak, 17 : 148-53.

Myuran T. .2017 .Improving visual assessment documentation in patients with periorbital trauma through an eye assessment teaching session and a proforma sticker. BMJ Open Qual, 6 : 1-4.

Kuhn F,Maisiak R,Mann L,Mester V,Morris R,Witherspoon C. .2002 .The Ocular Trauma Score (OTS). Ophthalmol Clin North Am, 15 : 163-6.

Ariga M,Sinnasamy M,Fredrick NT,Madanagopalan VG,Subashini V,Murali T .2023 .Medico-legal aspects in ophthalmology in India. TNOA J Ophthalmic Sci Res, 61 : 290-6.

Sharkiya SH .2023 .Quality communication can improve patientcentered health outcomes among older patients: a rapid review. BMC Health Serv Res, 23 : 1-27.