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100 Developing a quality assurance framework for neuro-ophthalmology referrals using NODE – the neuro-ophthalmology database
  1. Anoushka Lal1,
  2. Olga Roche1,
  3. Owen White1,
  4. Wendy Wang1,
  5. Shivanand Sheth2,
  6. Rahul Chakrabarti2,
  7. Lana del Porto2,
  8. Anthony Fok2,
  9. Neil Shuey2,
  10. Clare Fraser3,
  11. Lionel Kowal2 and
  12. Anneke Van der Walt1
  1. 1Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
  2. 2Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
  3. 3Sydney Eye Hospital, Sydney, NSW, Australia


Objective Quality assurance (QA) in neuro-ophthalmology (NOPH) is often lacking. The QA registry, NODE (Neuro-ophthalmology Database), was established and implemented in tertiary NOPH clinics in Australia. We developed a consensus on triage categories according to Australian standardised triage categories;P1 (consult<=30 days), P2 (consult<=30-60 days) and P3 (consult>60 days).

Methods Data on 410 patients at Alfred Hospital, Melbourne was collected with NODE. We developed a consensus on assignation of NOPH conditions to triage categories using recommendations from a panel of neuro-ophthalmologists with the modified Delphi approach. The average days from referral to triage and triage to the initial consultation were compared to the developed triage category standard.

Results Most patients presenting to the service were female (n=262, 64%), aged 21 to 30 years. Common diagnoses were Idiopathic Intracranial Hypertension, IIH (24%), Optic Neuropathy, ON (17%), Headaches, (11%) Cranial Nerve Defects, CND (9%) and Eye Movement Disorders, EOMD (9%). The mean time from referral to triage was <2 days for all the common NOPH conditions. The mean time (days, +-standard deviation) from P1 category triage to initial consult for IIH was 26 (±7), ON 27 (±11), and CND was 17 (± 5). The mean time (days) from P2 triage to initial consultant for Headaches was 27 (±12), and EOMD was (±17). The mean time (days) from P3 triage to initial consultant for Myasthenia Gravis was 30 (±10).

Conclusion We have established a consensus agreement on triage categories for neuro-ophthalmological conditions. We established a QA framework for other NOPH clinics in Australia.

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