Abstract
Objectives Quality assurance (QA) in neuro-ophthalmology (NOPH) is often lacking. We aimed to assess the quality of referral assessment and time-to-consult for common neuro-ophthalmological conditions by implementing a QA registry, NODE (Neuro-ophthalmology Database) in a tertiary Neuro-ophthalmology clinic. Australian standardised triage categories; P1 (consult<=30 days), P2 (consult<=30 to 60 days) and P3 (consult>60 days) were developed and validated for neuro-ophthalmological conditions.
Methods We collected data in NODE on 676 patients at Alfred Hospital, Melbourne and developed a consensus on the assignation of NOPH conditions to triage categories using a modified Delphi Approach with a panel of seven experienced neuro-ophthalmologists. We analysed the mean days from referral to triage, and from triage to initial consultation and compared these to the Australian standardised triage categories.
Results Common diagnoses were Idiopathic Intracranial Hypertension, IIH (19%), Optic Neuropathy, ON (14%), Non-specific Headaches, (11%) Cranial Nerve Defects, CND (8%) and Papilloedema (7%). The mean time from referral to triage was <5 days for all the common diagnoses. The mean days (±standard deviation (SD)) from P1 category triage to initial consult for IIH was 15 (±12), Acute ON 16 (±14), and CND was 20 (±15). For P2 triage-to-consult for Papilloedema was 20 (±19), non-specific Headaches was 22 (±20), and EOMD was 48 (±22). For P3 triage-to-consultant for Non-ocular Myasthenia Gravis was 38 days (±29) and for Visual Snow was 54 (±31 days).
Conclusions We established a NOPH registry that will serve as a framework to benchmark quality of care between NOPH services and improve clinical outcomes for patients.
