Are we missing vision loss? Visual acuity documentation in emergency department patients presenting with eye complaints

Introduction

Visual acuity (VA) is a fundamental and mandatory component of ophthalmic assessment, and documented VA testing is recommended for every patient presenting with an eye-related complaint (1). Failure to document VA is a recognised and common omission with potential clinical and medicolegal consequences (2). This closed-loop audit assessed the rate of VA documentation in Emergency Department (ED) patients presenting with eye complaints, with a subsequent teaching intervention and re-audit to evaluate improvement.

Methods

A retrospective review was conducted of all patients attending Princess Alexandra Hospital (UK) ED with eye-related complaints over a three-month period. Electronic records were reviewed to determine the proportion of patients who had VA documented during their ED attendance. Following this first cycle, a targeted teaching intervention for ED doctors was delivered, addressing the importance and practicalities of VA measurement. A second three-month data collection period will follow, allowing direct comparison of documentation rates pre- and post-intervention.

Results

Of 138 patients presenting with eye complaints during the initial audit period, fewer than 20% had VA documented in the ED. This represents a significant gap in standard ophthalmic assessment for this patient group. Re-audit data following the teaching intervention are pending and will be presented at the conference.

Conclusion

VA documentation in ED patients with eye complaints was substantially below expected standards, in line with similar audits reporting comparably low documentation rates. A targeted teaching intervention was delivered to address this gap, with re-audit data to determine whether education alone is sufficient to drive sustained practice change, or whether systemic changes (e.g. proforma redesign) are also required.

References

1. Evaluation of Visual Acuity. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
2. Chapter 153: Eye Examination. In: Emergency Medicine Procedures, 2nd ed. New York: McGraw Hill Medical.