Improving Red Reflex Screening in a Level III NICU Through a Quality Improvement-based Approach

Area of Science:

• Neonatal ophthalmology
• Quality improvement in healthcare
• Pediatric eye screening

Background:

• Red reflex examination is a standard, noninvasive newborn screening tool for detecting serious ocular abnormalities.
• The American Academy of Pediatrics recommends this exam before hospital discharge.
• The current documentation rate in US Neonatal Intensive Care Units (NICUs) was unknown, with a baseline of 19% noted in one level III NICU.

Purpose of the Study:

• To implement a quality improvement project aimed at increasing the documentation rate of red reflex examinations in a NICU.
• To achieve a documentation rate exceeding 80% for red reflex assessments.

Main Methods:

• A key-driver diagram was developed to identify potential interventions.
• Multiple interventions were implemented over four plan-do-study-act cycles, including staff education, visual reminders, discharge checklists, and improved ophthalmoscope accessibility.
• The project spanned 19 months of intervention.

Main Results:

• The study included 1168 infants discharged from the NICU without a formal ophthalmologist examination.
• Red reflex documentation rates significantly improved from a baseline of 19% to 89.5% during the intervention period.
• One case of abnormal red reflex was identified.

Conclusions:

• The quality improvement project successfully established a culture of improved documentation for red reflex examinations.
• This initiative is expected to reduce the incidence of missed diagnoses for serious visual abnormalities in newborns.
• Sustained focus on this screening can enhance early detection and management of pediatric eye conditions.