Project to mitigate risks for optometrists and improve patient outcomes receives VOTE grant

Collaborators on the project, L-R, Luke Arundel, Alexandra Jaworski, James Armitage, Amanda Douglass and Kwang Cham

By Helen Carter

Journalist

A project using e-learning and simulation-based modules to mitigate risks for optometrists and improve patient outcomes has received $9,500 in VOTE funding.

The project aims to deliver valuable simulation tools to help optometrists avoid diagnostic errors and improve patient communication. This should help mitigate risks for optometrists and patients, reduce claims and costs to practitioners and patients and improve patient safety.

The research team involving optometrists from Deakin University, Optometry Australia and the University of Melbourne was notified in December, 2020 that it would receive a 2020 Victorian Optometrists Training and Education (VOTE) Trust training and education grant to progress the idea.

Lead researcher, Deakin University optometry senior lecturer Dr Alexandra Jaworski, said purposefully designed e-learning and simulation-based modules would improve diagnostic accuracy and management in key areas of retinal health. Another aim was to improve communication of findings and management to patients via improved documentation and relaying of information, which reduces risks for optometrists and the profession, and collectively improves patient outcomes.

Stakeholders including optometrists, educators, placement providers, patients and patient advocates will provide input and feedback to ensure the e-learning and modules fit required needs. Resources will be designed after consultation with key stakeholders including Optometry Australia and relevant patient groups to ensure key retinal conditions and key aspects of documentation and communication are addressed.

Collaborators are Dr Jaworski, her Deakin optometry lecturer colleagues, Dr Amanda Douglass and Professor James Armitage, Optometry Australia’s Chief Clinical Officer Luke Arundel, and University of Melbourne senior lecturer Dr Kwang Cham.

Misdiagnosis costs can be great

Mr Arundel said: ‘Although serious complaints made against optometrists are relatively infrequent, their negative impacts and costs can be great and irreparable for the patient, optometrist, practice and communities involved, and the profession at large. This is particularly the case for incidents relating to misdiagnosis.

‘With regulatory body notifications and medico-legal action on the rise across all professions including optometry, the negative impacts and costs of these incidents can be extremely significant for patients, practitioners and the profession.  This is particularly the case for incidents relating to misdiagnosis or failure or delay in diagnosis, which can incur substantial non-monetary and monetary costs.’

The project evolved after the researchers were discussing how simulations could be used to improve training for students and continuing education for optometrists especially after COVID reduced face to face learning. They realised universities could collaborate better with Optometry Australia to improve continuing education that mitigates risks for optometrists and patients.

Dr Jaworski had been studying error detection and recovery for students as they transitioned to clinical settings, using videos. She started this work in Melbourne and continued at Flinders University.

‘The recent work Deakin, Melbourne and Flinders universities have collaborated on using simulation  supported that simulation is a useful adjunct to upskilling optometrists and training students,’ she said. ‘From this work, we have been considering future applications to improve patient safety.

‘The number of claims amongst health professionals, although infrequent, is steadily increasing, with misdiagnosis or delay in diagnosis of retinal conditions representing a significant proportion of these for optometrists.

‘Communication and record keeping are also identified as problem areas across all professions, so we were all in agreement that we were ideally positioned to try and close this loop using tools that we can see have worked in improving skills during training such as simulation, videos, self and peer reflection.’

Modules to improve accuracy and management 

Two pilot learning modules will be created, each encompassing one key retinal condition and two patient presentations.

The e-learning aspect will be interactive and designed to develop clinical decision making, documentation and patient communication skills for different patient contexts.

Videos of authentic patient presentations and exemplary and suboptimal record keeping and patient discussions will be created, and peer and self-review and reflection will be integrated to facilitate the development of these skills and promote independent, lifelong learning attributes.

Simulation using a donated Eyesi Indirect Ophthalmoscope will investigate if the training tool improves detection and diagnosis of retinal pathology. Participants will complete a practical adjunct using the simulator when they attend Deakin’s Waurn Ponds campus or the University of Melbourne.

Results are expected to inform future continuing education and training for optometrists and students.

The project has begun and aims to finish mid-2021.

The researchers will identify key features of incidents relating to diagnostic errors, and expand key aspects of diagnostic errors based on stakeholder input from patients, patient advocates, optometrists, Optometry Australia and educators. Videos will highlight clinical findings and management featuring patient presentations and discussions.

Importance of good record keeping

A minimum of 40 Victorian optometrists will be recruited to test interactive learning modules and give feedback, and patient feedback will be evaluated before finalising tools.

Dr Jaworski said missed diagnoses mostly related to clinical care while communication and record keeping (documentation of the patient encounter and explanation) also played a part in claims.

Missing an intraocular tumour or melanoma for example could come at a huge cost to patient and practitioner, she said.

But simulations could improve and upskill clinical skills and diagnosis while video simulations of good and suboptimal communication with patients and record-keeping would also assist.

‘Interactive modules can help with challenging conditions and ensuring optometrists diagnose in a timely fashion,’ she said. ‘Claims can also result from delays in diagnosis so record keeping must be an accurate reflection of the discussion between patient and practitioner, the diagnosis and the management, with rationale included for management explaining why the practitioner did or did not act in a certain way.

‘We will assess the pilot scheme to see how it enhanced diagnostic accuracy and record keeping and whether it had an impact.’

Patient advocates will inform where there may be issues and peer review of videos of mock discussions with patients and record keeping will be analysed to focus and design future learning modules.

Victorian optometrists interested in taking part in the pilot trial can email alexandra.jaworski@deakin.edu.au