Does your staff flag potential issues in patients’ charts to make it easier for physicians to catch them?

According to Edward J. Quinlan, MD, of Retinal Consultants of Arizona, flagging is a helpful reminder for surgeons. “We see many patients with other health issues, but we’re so focused on the eye sometimes that we need to pause and take time to thoroughly review their overall health.”

What to Flag
Dr. Quinlan pointed to several conditions and medications that he must be aware of before performing retina surgery on a patient.

Allergies: “We want to flag allergies for all patients. Allergies may affect medication choices. For example, if a patient has a sulfa allergy, then we avoid using carbonic anhydrase inhibitors to lower IOP.”

Recent thrombotic event: “Sometimes, a patient who has had a mini stroke may not tell us. It’s important to include this event in their history so we’re aware of it. These patients need a thorough evaluation by their primary care physician or cardiologist before undergoing any surgical procedure to ensure that they are stable to undergo anesthesia and surgery.

"Patients with significant carotid artery disease are at increased risk for developing a cerebrovascular accident (stroke) as well as a retinal artery occlusion,” says Dr. Quinlan.

Blood thinners: “It’s important for me to know if a patient is taking blood thinners or even aspirin. Patients with wet AMD who are using blood thinners may be at higher risk for developing massive submacular hemorrhages."

“I often treat these patients more aggressively than patients not using blood thinners. For instance, I’m more likely to treat these patients with a continuous monthly regimen with an anti-VEGF agent rather than a PRN approach in which patients only receive treatment if there are signs of reactivation of choroidal neovascularization in the exam or on OCT.”

Diabetes, high blood pressure or kidney disease: “We must know whether or not these conditions are well controlled. For example, if a diabetic patient has proliferative diabetic retinopathy and is experiencing bleeding in the eye (vitreous hemorrhage), then we need to ensure that the patient’s blood sugar and blood pressure are well controlled prior to entering the operating room. If the blood pressure is markedly elevated during surgery, it may place the patient at greater risk for intraoperative and postoperative bleeding, which may compromise the success of the surgical procedure. Uncontrolled high blood pressure also exacerbates DME and may compromise treatment of this condition as well.”

Training Your Staff
For staff to flag key information for physicians, they need training. For starters, administrators should ask physicians to list the health problems and medications that affect their treatment decisions. The system by which staff flag those issues and communicate them to physicians will vary based on your EMR system and how handoffs are performed (i.e., if paperwork is passed along). Develop a method for your practice that ensures relevant health information isn’t overlooked.