Quality Improvement: Adopting Best Practices for Exceptional Outcomes

Dec 08, 2021 11:00 AM


Photo illustration of an eye.

University of Utah Health has led the way as health care systems nationwide pursue process and policy improvements. For the past 12 years, U of U Health has placed among the Top 10 nationally in the Vizient Quality and Accountability Ranking system.

At the John A. Moran Eye Center, this commitment extends to a broad range of measures to provide the best possible procedural outcomes.

Rigorous Data Monitoring

Moran employs an extensive data monitoring system and communicates well-established expectations to ensure the highest quality of care in clinics and operating rooms.

To objectively and prospectively collect information on surgical complications, Moran digitally records every surgery and uses an “every-case-every-time” philosophy for reporting. Every surgeon is expected to attest that there was or was not a complication for every case. This assures surgical complications are reported in all instances.

Moran reviews and verifies the reports, comparing them with independent data points, such as equipment or supplies used in surgical cases with complications.

For example, every case of endophthalmitis is reviewed by Moran’s QI group and division representatives, U of U Health Infection Prevention Department, and others in the hospital system. A weekly review of intraocular antibiotic injections assures monitors can discover any potential worrisome trends.

Infection Prevention

Moran adheres to top-rate infection prevention standards set by the Association for the Advancement of Medical Instrumentation, International Association of Healthcare Central Service Materiel Management, Association of periOperative Registered Nurses, Association for Professionals in Infection Control and Epidemiology, and American Society of Ophthalmic Registered Nurses. These organizations are vital in helping Moran maintain current evidence-based best practices. They also provide critical resources for continuing education and certification for ophthalmic medical employees that go beyond state requirements.

Moran sets its high standards in collaboration with U of U Health and its Infection Prevention Department, partners that share the same mission of patient safety and quality care. Moran’s Sterile Processing Department was the first in the U of U Health system to achieve zero percent immediate-use steam sterilization (IUSS), a remarkable achievement for the past four years. IUSS is no longer an acceptable practice, and all instrumentation is now completely reprocessed before it goes back into service.

Moran is a national leader in developing infection prevention protocols, including participation in a national task force addressing Toxic Anterior Segment Syndrome (TASS), a rare but potentially sight-threatening condition. Led by Nick Mamalis, MD, co-director of the Intermountain Ocular Research Center based at Moran, the task force helped develop national guidelines for cleaning and sterilizing intraocular surgical instruments to protect eye surgery patients from TASS.

Individualized Training and Mentoring

Faculty monitor the advancing skill levels of Moran residents and fellows, who gradually perform more complex surgeries as their skill levels increase.

Moran faculty members also identify each trainee’s strengths and tailor mentoring to their unique needs—all part of an ophthalmology education program consistently ranked as one of the best in the nation.

Residents and fellows train virtually on Moran’s in-house surgical simulator. Moran also recently became a test center for a unique small-incision cataract surgery simulator-based training system by HelpMeSee.

Research Projects and Studies

Residents and faculty are actively engaged in an extensive QI and clinical studies program.

Resident QI Projects

Moran’s residents are required to design and implement QI projects as part of their training. Recent projects include:

  • Establishing the Underrepresented Minorities in Medicine (URiM) Scholarship to encourage URiM applicants.
  • Designing and implementing a revamped reverse-classroom curriculum that stresses interactive blended learning over traditional lectures.
  • Expanding processes and experiences for the ophthalmology-incorporated intern year.
  • Providing nocturnal intraocular pressure-measuring devices for Salt Lake City Veteran’s Administration Hospital glaucoma patients.
  • Developing a protocol for exposure keratopathy in ICU patients.

 

A demonstration of a virtual visual field device being used in a clinical exam room.
A demonstration of a virtual visual field device being used in a clinical exam room.

Faculty Study: Expanding Access to Visual Field Testing

Meagan D. Seay, DO, recently led a quality improvement study that found use of a virtual visual field (VVF) device improves patient care in acute hospital settings.

The team introduced the virtual visual field devices to inpatient and on-call settings to improve access to formal visual field testing, which is typically only available in comprehensive eye care clinics.

While physicians use the device for patients with all types of visual symptoms, the team was particularly interested in the potentially improved outcome for patients admitted for lumbar spine drains placed to treat vision-threatening optic nerve edema.

They found the VVF devices to be especially beneficial for patients in the ICU to avoid difficult and potentially dangerous trans­port to an eye clinic for the testing.

The team presented its findings at the 2021 North American Neuro-Ophthalmology Society meeting.

vision research patient care