A Quality Improvement Project of Acute Red Eye Consultations in Primary Care: Improving the Identification of Red Flags

Abstract

Aim The acute red eye or conjunctival injection is the most common ophthalmic presentation in primary care. The aim of this audit was to improve red eye consultations by increasing the number of red flag features documented in the history of patients. Method The National Institute of Clinical Excellence (NICE) Clinical Knowledge Summary (CKS) outlines red flag features, which should be documented for an acute red eye consultation. Two interventions were implemented to attempt to improve consultations. The first involved creating a template in the Egton Medical Information Systems. The second involved training doctors in the recognition of red flag features and identifying sight-threatening conditions. Red eye consultations and red flag features documented were recorded in the two months before and after the interventions. Results All documentation of red flag features assessed in this project increased post intervention. However, lateralisation, visual changes, and eye pain were commonly asked prior to the intervention and did not show a statistically significant difference. They showed an increase from 90% (19/21) to 100% (19/19), 71% (15/21) to 84% (16/19), and 67% (14/21) to 79% (15/19), respectively. After the interventions, significant increases in asking about headaches (14% (3/21) to 74% (14/19), pupil changes (5% (1/19) to 58% (11/19)), and method of injury (high velocity 10% (2/21) to 84% (16/19), foreign body 14% (3/21) to 84% (16/19), chemical 10% (2/21) to 84% (16/19) were observed (p<0.05). Photophobia inquiries also significantly increased (14% (3/19) to 79% (15/19), P<0.05). Conclusion The number of red flag features identified and documented for acute red eye consultations increased with the introduction of an online template and a teaching session.

Keywords: acute red eye; conjuntivitis; ophthalmology; ophthalmology consultations; quality improvement; red flag symptoms.

Figure 1. An EMIS template created for consultations for patients presenting with acute red eye. Red flag features are displayed and can be ticked if present or not present

EMIS: Egton Medical Information Systems (EMIS Health, Leeds, United Kingdom)

Figure 2. Red eye differential diagnosis algorithm used for teaching acute red eye consultations in a GP Practice

GP: general practitioner Image Source: Ho et al., 2021 [9]; Open Access, CC BY-NC 4.0 license

Figure 3. Consultations in which red flag features were asked of patients presenting with acute red eye.