Organizational intervention to improve access to retinopathy screening for patients with diabetes mellitus: health care service improvement project in a tertiary public hospital.

Abstract

The aim of this study was to improve the access to diabetic retinopathy (DR) screening with retinographies in a tertiary care center through a process conducted by an interdisciplinary group driven by a nurse. This is a quality improvement study that evaluated the flow for DR screening conducted by an interdisciplinary group using the Plan-Do-Study-Act methodology. As a result measure, we assessed the quantity of retinographies performed after the project implementation, the proportion of patients who presented abnormal retinographies, and the proportion of patients referred to a specialist. The new patient screening flow and the reinforcement of available human resources led to an increase in the number of retinographies performed and screened patients. A total of 1184 retinographies were conducted, and it was possible to observe DR alterations in 37.8 % patients, of which only 6 % needed to be referred to the DR reference center. This study showed a significant increase in the number of retinographies performed. The Plan-Do-Study-Act methodology was an important tool to improve the flow of patient access to fundus images, helping to consistently and continuously improve these processes.