Risk Management and Healthcare Policy (Sep 2021)
Pitfalls of Advanced Retinopathy of Prematurity Presentation: A Content Analysis of Medical Records
Abstract
Lojain AlBathi,1 Noura Abouammoh,2 Nayef AlSwaina,3 Hani B AlBalawi,4 Abdullah A Al Qahtani,5 Mohammed Talea,6 Sulaiman M AlSulaiman,7 Marwan A Abouammoh1 1Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Community and Family Medicine, King Saud University, Riyadh, Saudi Arabia; 3Department of Ophthalmology, College of Medicine, Qassim University, Buraidah, Saudi Arabia; 4Department of Ophthalmology, College of Medicine, Tabuk University, Tabuk, Saudi Arabia; 5Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 6Department of Ophthalmology, Asir Central Hospital, Abha, Saudi Arabia; 7King Khaled Eye Specialist Hospital, Vitreoretinal and Uveitis Divisions, Riyadh, Saudi ArabiaCorrespondence: Marwan A AbouammohDepartment of Ophthalmology, College of Medicine, King Saud University, P. O. Box 245, Riyadh, 11411, Saudi ArabiaEmail [email protected]: To identify the pitfalls in retinopathy of prematurity (ROP) screening leading to advanced disease at Ministry of Health (MOH) hospitals in Saudi Arabia.Methods: A qualitative deductive content analysis was used to study the phenomena of defects in ROP screening. A retrospective review of medical records of newborns presenting to two tertiary eye care centers with advanced ROP (stage 4 and 5) from January 2012 to June 2019 was completed. An extensive review of the original files at the referring hospitals was conducted, including the general condition and findings of ophthalmic examination and the sequence of follow-up until the infant was discharged/referred. Data analysis was completed using pre-structured categorization matrix.Results: Records of 29 infants with advanced stage ROP were identified. Only 13 medical records were available and obtained. The pitfalls in screening found in the study were failure to refer by the neonatologist, delayed follow-up by the ophthalmologist, failure to follow-up by the ophthalmologist, failure to diagnose by the ophthalmologist, poor documentation in patient files, unavailability of ophthalmologist, family negligence, lack of treatment and delayed referral to a higher center, and progression despite timely screening and management.Conclusion: Although clear ROP screening guidelines are available, implementations of these guidelines are suboptimal. This study showed that the most common defect in screening is physician’s inadequacy and unavailability. A proper network of competent ROP screening physicians in all neonatal intensive care units should be established. Centers for advanced ROP surgery should be allocated to deliver a timely surgical care if needed.Keywords: retinopathy of prematurity screening, pitfalls, content analysis
