Replacing the postoperative week 1 visit after routine phacoemulsification with a telephone consult.

OBJECTIVE: To assess the safety of replacing the postoperative week 1 (POW1) clinic visit with a nurse-conducted telephone call. DESIGN: Retrospective observational study that included cases from January 2019 to June 2021. PARTICIPANTS: Patients who had undergone uncomplicated phacoemulsification surgery with an unremarkable postoperative day 1 (POD1) examination. METHODS: All patients were seen in clinic on POD1 by an ophthalmologist. They then had a telephone conversation with a nurse at POW1 and subsequently an in-person postoperative month 1 (POM1) clinic consultation with an ophthalmologist. Main outcome measure was the incidence of unexpected management changes related to cataract surgery within POM1. Data also were collected on the reasons for unscheduled patient-initiated visits, additional procedures or medications, and postoperative visual acuity worse than 6/12 at POM1. RESULTS: Of the 20,475 patients, 541 patients (2.64%) had an unexpected management change within POM1. There were 565 patients (2.76%) who had self-initiated unscheduled visits between POD1 to POM1. There were 23 patients (0.11%) who required additional surgery within POM1 and 1 patient (0.005%) with endophthalmitis. The most common indication for additional surgical procedures was retained lens material (7 patients, 30.43%). Visual acuity was worse than 6/12 in 1,199 patients (6.22%), with the most common causes attributed to preexisting ocular conditions. CONCLUSIONS: These results suggest that replacing the POW1 visit with a nurse-conducted telephone consult for patients who have undergone uncomplicated phacoemulsification surgery and had a normal POD1 consultation is safe.

Linear versus Quadratic Detrending in Analyzing Simultaneous Changes in DC-EEG and Transcutaneous pCO2.

Physiological direct current (DC) potential shifts in electroencephalography (EEG) can be masked by artifacts such as slow electrode drifts. To reduce the influence of these artifacts, linear detrending has been proposed as a pre-processing step. We considered quadratic detrending, which has hardly been addressed for ultralow frequency components in EEG. We compared the performance of linear and quadratic detrending in simultaneously acquired DC-EEG and transcutaneous partial pressure of carbon dioxide during two activation methods: hyperventilation (HV) and apnea (AP). Quadratic detrending performed significantly better than linear detrending in HV, while for AP, our analysis was inconclusive with no statistical significance. We conclude that quadratic detrending should be considered for DC-EEG preprocessing.

Reducing the number of invalid surgical consents in the day surgery unit.

AIM: To reduce the number of invalid surgical consents in the Singapore National Eye Centre Day Surgery Unit over a period of 6 months. METHODOLOGY: A multidisciplinary team involving doctors, nurses, day surgery unit, operating theatre, listing and clinical audit staff looked into the listing process and the root causes of the high number of invalid consents. A Pareto chart detailing the top causes of invalid consents was drawn, and with a prioritisation matrix, feasible yet effective changes were identified and effected. Plan-Do-Study-Act (PDSA) cycles included moving consent checks upstream, getting invalid consents amended on the same day, sending emails to raise awareness on invalid consents and posters in clinics to emphasise the correct way to fill up consent forms. RESULT: There has been a progressive downtrend in the monthly mean percentage of invalid consents since the introduction of PDSA cycles. There was a significant reduction in the mean rate of rejected consents from the preintervention phase of 15.2% to the postintervention phase of 11.3%, shown with a Z score of 6.56 (P<0.05). Sustainability was also demonstrated with multiple consecutive points below the median of 14.5% on the postimplementation phase of the run chart, with estimated time-efficiency savings of USD$19 738.50 annually. CONCLUSION: Errors in the workplace can be reduced with a concerted effort from multiple stakeholders. It is important to have a thorough look at processes with concerned parties, so that different perspectives and skill sets can be harnessed to determine and implement feasible and effective interventions.