Preappointment dilation drops for retinopathy of prematurity examination visits: an equitable intervention to reduce clinic time regardless of insurance status.

PURPOSE: To evaluate the results of a quality improvement study designed to enhance retinopathy of prematurity (ROP) clinic workflow at a large academic children's hospital by having care givers predilate the eyes of children prior to their screening.

METHODS

The study was conducted prospectively from February 1, 2023, to May 31, 2024. Predilation drops were prescribed for caregivers to administer 90-minutes prior to ROP appointments. A discounted mail order pharmacy option was made available to ensure access to dilation drops at a maximum of $40 regardless of insurance status. Primary outcome was median clinic time (check-in to check-out) for ROP patients, with additional analysis of adverse events and clinic time variations by insurance type.

RESULTS

A total of 918 ROP examination visits were included. All patients who underwent ROP evaluation at the clinic during the study period were eligible; no exclusion criteria were applied. The median clinic time decreased from 81.7 minutes to 61.9 minutes, saving 19.8 minutes per visit (P < 0.001). Predilation rates increased to 52% of patients by the study's conclusion. There were no significant differences in time savings across insurance types (P = 0.536), and no adverse events were reported.

CONCLUSIONS

In this study, integrating predilation drops into our workflow reduced clinic time for ROP screening visits. The intervention was equitable across diverse patient populations, including those with differing insurance and socioeconomic statuses, and no adverse events were recorded.