Toward Achieving 100% Adherence for Retinopathy of Prematurity Screening Guidelines

Arnold, Robert W.; Jacob, Jack; Matrix, Zinnia

doi:10.3928/01913913-20170329-04

Cited by 5 publications

(7 citation statements)

References 4 publications

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“…Additional demographic and medical record data were retrieved from ROP Check software. 11 The Providence NICU utilizes American Academy of Pediatrics (AAP) ROP scheduling guidelines. 12 The smaller and least stable premature infants had additional nursing and respiratory therapy support during exams.…”

Section: Methodsmentioning

confidence: 99%

<p>Oculocardiac Reflex During ROP Exams</p>

Schumacher¹,

Ball²,

Arnold³

et al. 2020

OPTH

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Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/XB2uu1ca7kQ Purpose: Reducing physiologic stress including bradycardia during staging eye exams for retinopathy of prematurity (ROP) is desirable. We observed heart rate change during routine retinopathy of prematurity eye examinations and compared the response with our ongoing study of oculocardiac reflex (OCR) elicited by uniform EOM tension during strabismus surgery. Patients and Methods: Electrocardiograph was prospectively monitored during ROP exams featuring indirect ophthalmoscopy with Alfonso lid speculum and see-through scleral depressor without topical anesthesia. Clinical data were retrieved from ROP-Check software. OCR was defined as maximally changed heart rate (HR) as a percent of baseline. Strabismus surgery patients under general anesthesia served as controls. Results: From 10/2017 to 9/2020, 281 infants had ROP exams, and the median OCR was 55.9% of baseline HR (IQR 41.4% to 72.6%), the kurtosis 0.93 and skewness 1.01 representing a drop from HR 169 ± 16 bpm to 102 ± 39 bpm. In comparison, 1493 adult and pediatric strabismus surgery patients had less OCR median bradycardia 87.8% (IQR 72-98%), kurtosis 1.60 and skewness −1.18. ROP %OCR correlated with birth gestational age (%OCR = 2.5 (GA)-11, r(279)=0.33, p<0.01) and with birthweight (%OCR = 0.02 (BW) + 38, r(279) =0.35, p<0.01). The duration of bradycardia induced by ROP exam averaged 92 ± 34 seconds (range 34-240 seconds). Conclusion: Bradycardia is common during eye exams in the smallest premature infants with greater degree, more rapid onset and longer duration than OCR during strabismus surgery.

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Section: Methodsmentioning

confidence: 99%

<p>Oculocardiac Reflex During ROP Exams</p>

Schumacher¹,

Ball²,

Arnold³

et al. 2020

OPTH

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“…Such studies suffer from study [17]. Furthermore, we have previously demonstrated that current AAP screening guidelines performed exceptionally well in providing a safety net for capturing all infants, even those at low risk for severe ROP [15], adding caution to the notion of modifying AAP screening guidelines in a clinical practice setting. Finally, there has been work on a telemedicine approach to addressing ROP workload [10].…”

Section: Discussionmentioning

confidence: 99%

“…Incomplete retinal maturity in an infant otherwise ready for discharge from the NICU places pressures on neonatologists for discharge. Our previous study showed that outpatient ROP care is common in some institutions and that many such infants have advanced ROP and frequently have missed or delayed appointments, making this a high-risk practice for ophthalmologists, neonatologists, NICUs, and primary care pediatricians [15]. Therefore, discharge from NICUs for babies who have not achieved retinal maturity is another potential productive area for quality improvement and collaboration between neonatologists and ophthalmologists.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with retinopathy of prematurity ophthalmology workload

Jacob

Matrix²,

Skopec

et al. 2018

J Perinatol

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ObjectiveThis article reports on retinopathy of prematurity (ROP) workload in the NICU related to severity of disease, gestational age at discharge, and practice variation.Study designData analysis on 1771 patients ≤ 30 weeks of gestation at birth from a de-identified data set of 13 NICUs.ResultsThere was a positive relationship between the severity of ROP and (1) the number of exams per patient, (2) the severity of ROP, and (3) postmenstrual age at discharge. The progression between the stages of ROP added to exam workload and postmenstrual age at NICU discharge. The addition of plus disease did not increase the exam burden. There was significant practice variation in the number of exams performed independent of ROP severity.ConclusionThe progression of the severity of ROP independent of plus disease, and practice variations both contribute to ROP workload. Addressing these factors could decrease ROP workload without compromising American Academy of Pediatrics (AAP) guidelines.

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“…One group out of Alaska designed a computerized system specifically designed around ROP with built-in guidelinebased treatment protocols. 6 The benefit of this program was a standardized approach for all stakeholders including the ophthalmologists, neonatologists, hospitals, and general pediatricians.…”

Section: Introductionmentioning

confidence: 99%

Retinopathy of Prematurity—Using Electronic Medical Records to Efficiently Follow Patients at Multiple Hospitals

Schultz

Gaffar

2021

Journal of Neonatology

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Purpose: To report the use of a centralized electronic medical record (EMR) to provide timely retinopathy of prematurity (ROP) screening in a previously fragmented monitoring system in a standalone children’s hospital in Connecticut. Methods: A chart review of 306 visits for ROP screening in 3 neonatal intensive care units (NICUs) over a time period of 24 months. Results: All infants born at <30 weeks gestational age or birth weight <1,500g (N = 107) at these NICUs were screened for ROP according to the American Academy of Pediatrics guidelines. Data was collected before the implementation of our centralized EMR list, during a transitional period, and once the list was established. Our analysis of the data found an improvement in delay of care from 16.85% to 10.83% of visits, and a decrease in number of visits done during off hours from 20.4% to 5% of visits. Conclusion: Our tool was a free and cost-efficient centralization of a once difficult-to-manage process for ROP screenings in Connecticut. The decrease in delay of care and improvement in physician scheduling will lead to better outcomes for our patients and better sustainability of practice for our providers.

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Toward Achieving 100% Adherence for Retinopathy of Prematurity Screening Guidelines

Cited by 5 publications

References 4 publications

<p>Oculocardiac Reflex During ROP Exams</p>

<p>Oculocardiac Reflex During ROP Exams</p>

Factors associated with retinopathy of prematurity ophthalmology workload

Retinopathy of Prematurity—Using Electronic Medical Records to Efficiently Follow Patients at Multiple Hospitals

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