IMPROVING THE ACCURACY OF VISUAL ACUITY MEASUREMENT IN THE EMERGENCY DEPARTMENT

Visual Acuity (VA) is a common measurement used to assess the ability of the eye to distinguish shapes and the details of objects at a given distance [1]. It is important to assess VA in a consistent way in order to detect any changes in vision at the next visit [1]. With many VAs being left out or done incorrectly on referrals, the ophthalmology doctors can find it challenging to triage effectively. Furthermore, an eye assessment which omits VA could strongly undermine a clinician’s defense if the case is brought to court.

In the Salisbury Emergency Department (ED), all eye patients are expected to have their VA measured using the snellen chart in the eye room. If a patient needs to be referred to the eye department, a form is completed, scanned and sent. The eye department expects that basic tests such as VA are always recorded to help the team effectively triage. This project aims to improve the compliance with measuring VA in ED.

We carried out a closed loop audit on the referrals from the emergency department to the eye clinic. During April we measured the compliance with measuring VA. We found that compliance with measuring VA was only 64%. Moreover, in over 64% of the referrals we received from the emergency department, VA was either not done or at least 2 lines off the measurement in the follow up emergency eye clinic. This was despite the ED staff having access to a snellen chart in the Emergency Department’s eye room, where they would have seen the patient. To correct this we designed a poster that explained in simple steps with a flowchart, how to take an accurate visual acuity. This was placed next to the snellen chart for maximum impact.

After the VA flowchart was implemented in ED we re audited the compliance with VA measurement and we found that it increased from 64% to 84%. In addition, we arranged informal teaching and collected feedback from ED staff (Consultants, Junior Doctors and Nurses) which were overwhelmingly positive.

The Emegency Department in Salisbury Hospital have agreed to publish the flowchart onto the ‘Microguide’ for Salisbury NHS Foundation Trust which can be accessed by other trusts. A portable A4 poster with a snellen chart on one side and the guidelines on the back will be printed for staff to use on the wards and for patients in ED Majors who cannot leave their bed. If successful, a PDF version will be enrolled onto all iPads in the trust to make it more environmentally friendly and accessible. After several months, more formal feedback will be obtained from ED staff and supplemental teaching will be arranged if compliance falls again.