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Getting started with the National Dataset
Collecting binocular unaided visual acuities ? doing the simple things well
Collecting binocular unaided visual acuities – doing the simple things well
Section 7.2 of the April 2017 Professional Standards for Refractive Surgery states:
7.2 Wherever possible, electronic patient record systems should record standard audit outcomes, readable by and contributing to a national database of refractive surgery outcomes.
In March 2018, the National Dataset for Refractive Surgery was published on the Royal College website. This sits alongside similar sets of standard outcome measures agreed for cataract Surgery, corneal collagen cross-linking, macular hole surgery, and retinal detachment surgery, and was developed in the same methodology.
The advantages to automatically collecting and pooling outcome data from electronic healthcare record (EHR) systems nationally are obvious. At an individual level, it should provide us all with the information we need as evidence for revalidation. More importantly, it will provide timely real-world information about which lasers, implants and techniques are providing the best results for each patient group.
We are several steps away from building a national registry on the foundation of the minimum dataset, but there is a lot we can do in our practices and clinics now to get this moving.
First, download the dataset and start embedding each component into your clinical routines with your optometrists and technicians.
If you are not already working with EDTRS charts and LogMAR acuities, this is the first step. Screen based systems for this have real advantages. Several systems are available commercially. We are using CompLog at Moorfields, and have found the automation of data capture, letter counting, test routines and stop criteria particularly helpful.
You also need to build binocular unaided visual acuity testing into your refraction routine. We are testing at 4m (distance) 63cm (intermediate) and 40cm (near) in that order. It takes two to three minutes at most – keep in mind that intermediate and near vision testing is not required in anyone under 40. You can review advice on testing methods in the assessment tab of the National Dataset spreadsheet.
Once you have embedded these small culture changes into your clinical routine, the next step is to ensure that the National Dataset fields are all there in your provider’s EHR system or electronic audit database.
In the next year, we will work on a funding and implementation strategy for national audit. This will require a sprinkle of diplomacy and a ton of work. Even if we only get as far as collecting data in a common format, we will have taken our audit of refractive surgery in the UK to a better level. So, let’s get going!