Communication, protocol essential for safe ROP screening, care

Issue: May 25, 2010

Pediatric ophthalmologists and retina specialists who conduct retinopathy of prematurity screenings and treatment should establish a safety net of protocol for care, in addition to appreciating the unique role that neonatologists, nurses and families play in consistency of follow-up.

“The bottom line is that a safe, successful program is working with the neonatologist and creating a safety net to make sure that the patients are seen, both in the hospital properly and outside of the hospital,” Robert S. Gold, MD, OSN Pediatrics/Strabismus Section Editor, said in a telephone interview with Ocular Surgery News. “Part of making sure the patients are seen properly is making sure you have a protocol. That’s what we talk about when we say ‘creating a safety net.’”

Dr. Gold recommended that physicians who are involved in ROP screening and treatment read the Ophthalmic Mutual Insurance Company’s (OMIC) “Retinopathy of Prematurity: Creating a Safety Net” document. The free document, located on OMIC’s website, details the best ways of establishing an effective ROP protocol.

Many retina specialists and pediatric ophthalmologists are reluctant to screen and care for ROP patients because of regulations and liability issues, he said, creating a shortage of physicians willing to oversee ROP cases. Unless more physicians are willing to establish effective protocols for better legal protection, that shortage could continue, he said.

Dr. Gold conducts ROP screenings at two large neonatal intensive care units (NICU) with a set protocol.

“This is one of the biggest medical/legal issues facing pediatric ophthalmology,” Dr. Gold said. “Not only that, but it is the major reason why so many pediatric ophthalmologists and retina specialists want nothing to do with ROP screening. My feeling at this time in my career is, this is part of what we do as a pediatric ophthalmologist. It’s part of the scope of our practice. That’s why I do this. Am I taking a risk? You take a risk every time you walk into a room with a patient.”

Factors for success

Merrill Stass-Isern, MD, has led the Children’s Mercy Hospital ROP screening program since 1989. In an interview with OSN, she said ROP screenings are best performed by trained physicians.

“I would discourage ophthalmologists from agreeing to do screening unless they’ve had proper training,” she said. “It’s not an easy thing to do. … It is an art which is constantly evolving and changing. There are new findings we are seeing with micro-preemies, including the timing and progression of their disease.”

She said several factors have contributed to changes in ROP screening in recent years, including an increase in the number of premature infants and a decrease in their gestational age. In the past, retina specialists often conducted ROP screenings, but pediatric ophthalmologists have been steadily performing more screenings in level-3 nurseries over the last few years.

“I think the key element is consistency among all the players,” Dr. Stass-Isern said. “It has to be just a few ophthalmologists that have similar practice patterns. You can’t have several different ophthalmologists in one program requiring different equipment, with different screening and/or treatment protocol. That’s not going to work.”

She said NICU nurses are the “glue of the whole screening program.” At Children’s Mercy Hospital and other hospitals in its screening program, one to three NICU nurses are specifically assigned to the ROP team. Those nurses are in charge of readying infants for examination, stocking the screening equipment cart, providing written information about ROP and, most importantly, she said, establishing a close relationship with families to facilitate excellent follow-up.

Communication

Additionally, communication and coordination between physicians and hospital administrations is necessary for successful ROP screening programs, Dr. Stass-Isern said. Many pediatric ophthalmologists began entering into contracts with hospitals several years ago to better define their services and role in ROP screening and treatment.

“It’s always important in any hospital … that a commitment is put forth by the administration and the department of neonatology and ophthalmology,” she said. “The administration has to realize that it costs money to run the program. The neonatologists have to make the commitment to make sure they identify the children that need to be screened. And the ophthalmologist has to commit the time to properly screen and treat these children.”

When Dr. Gold screens patients, coordinators in the NICU and his home office share information about scheduling, hospital transfers and follow-up. He said it is important that families who do not attend an appointment are contacted in at least three ways: by telephone, mail and certified mail.

Communication between physician and family is also vital, he said.

“The key to doing a successful ROP screening program is that the babies are tracked properly and that no baby gets missed in follow-up,” he said. “That’s not only within the hospital, but when they’re discharged.” – by Erin L. Boyle

Robert S. Gold, MD, can be reached at 225 W. State Road 434, Suite 111, Longwood, FL 32750; 407-767-6411; fax: 407-767-8160; e-mail: rsgeye@aol.com.
Merrill Stass-Isern, MD, can be reached at 5808 W. 110 St., Overland Park, KS 66211; e-mail: mstass-isern@cmh.edu.
To access OMIC’s “Retinopathy of Prematurity: Creating a Safety Net,” go to http://www.omic.com/products/bus_products/announce/ann_jun07.cfm.