Structured clinical proforma to reduce delay of initial treatment for cases of suspected endophthalmitis

Sukhpal Sandhu

Meeting:  2015 RANZCO


Date:      -

Session Title: Poster

Session Time:      -

Purpose: Endophthalmitis is a potentially blinding condition that requires urgent aqueous/vitreous biopsy and intravitreal drug therapy (ëtap and injectí). An endophthalmitis treatment clinical pathway proforma to aid management was introduced in a tertiary hospital eye Emergency Department (ED). This study assessed compliance and effectiveness of the proforma and factors causing delay in treatment for cases of suspected endophthalmitis.

Method: Retrospective review of all cases of suspected endophthalmitis presenting to ED since the introduction of a proforma in 2012 for a 2-year period. Patients were stratified into two groups for whom clinicians utilised the clinical proforma or not, but all patients received standard care. The primary outcome was ëdoor-to-needleí time. Secondary outcomes were factors causing delay in treatment.

Results: There were 63 cases of suspected endophthalmitis with a mean age of 69.7 years (range:13-95) and 54% males. The clinical proforma was used in 33% of presentations, and had complete documentation in 81%, which compared with 67% and 26% when not used. The door-to-needle time was 226 (95%CI:181-271) minutes overall, 212 (95%CI:157-268) minutes when the proforma was used and 247 (95%CI:113-381) minutes when not (p=0.95). It was 247 (95%CI:212-282) minutes when managed in theatre. Factors associated with faster treatment were pre-diagnosed referrals for endophthalmitis, presenting after hours, country residence and both post-procedural/post-operative aetiologies.

Conclusion: There is a 35-minute improvement in door-to-needle time when the endophthalmitis treatment clinical proforma is utilised in a busy eye ED. Rapid triage, complete documentation and effective communication facilitated by a proforma can lead to reduced door-to-needle times.