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Multidisciplinary approach to improving documentation of visual acuity in patients presenting with ocular trauma


This study aimed to implement a multidisciplinary quality improvement project in Perth Royal Infirmary A&E department to improve documentation of visual acuity (VA) in patients presenting with ocular injury.


The improvement project involves a three-pronged multidisciplinary approach: ensure that equipment required for VA testing (Snellen chart and pinhole mask) was readily available; encourage VA testing at first point of contact with A&E staff, both nursing/medical staff; and refresher online course on how to test for VA quickly and accurately, in the 6/X format. We compared the pre-intervention (2 September to 2 October 2012) and post-intervention (11 October to 19 November 2012) rates of VA documentation using the chi-square test.


During the pre-intervention period, of a total of 44 patients who presented to A&E with eye injury, only 36 patients (95%) had their VA tested. Following intervention, there was significant improvement in VA testing, where all 43 patients presenting to A&E with eye injuries had their VA tested (100%, P = 0.02). Documentation of VA in the correct (6/X) format increased from 82 to 84% following intervention. There was a 15% improvement in documentation of best-corrected VA, from 48 to 63% post intervention. See Figure 1.

Figure 1

Acute inferior MI with complete heart block.


Through a multidisciplinary approach, we were successful in achieving our target of 100% VA documentation rate in all patients presenting with eye injury to PRI A&E.

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Correspondence to L Low.

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Low, L., Johnston, M. Multidisciplinary approach to improving documentation of visual acuity in patients presenting with ocular trauma. Crit Care 17, P265 (2013).

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  • Visual Acuity
  • Emergency Medicine
  • Quality Improvement
  • Post Intervention
  • Multidisciplinary Approach