Effectiveness and future implications of COVID-19-related risk stratification for managing retinopathy of prematurity: The Indian twin cities retinopathy of prematurity study report number 10

Abstract

Purpose: To evaluate the effectiveness and future implications of COVID-related risk stratification for managing retinopathy of prematurity (ROP). Methods: A prospective study was conducted at a tertiary eye care center from the beginning of the lockdown in India from 23 March 2020 till the end of the first phase of lockdown on 29 May 2020. We evaluated 200 prematurely born infants (< 34 weeks of gestational age) using the new safety guideline protocols for low-risk babies developed in conjunction with the Indian ROP Society for care during the COVID-19 pandemic. Low risk included babies born at more than 30 weeks of gestational age, post menstrual age 34 weeks or above at presentation, more than 1000 grams of birth weight, and stable systemically with good weight gain. Results: New guidelines were implemented in 106 (53%) infants who were low risk while 94 (47%) infants with high risk were followed up as per the old guidelines. Out of the 106 infants (212 eyes) managed by the new guidelines, good outcome (group 1) was seen in 102 (96.2%) infants. Twenty-seven of the 102 infants had some form of ROP and 5 of these infants needed treatment. None of the low-risk babies with no detachment at presentation managed by new guidelines required surgery later (group 2). Two (1.9%) infants came with retinal detachment at presentation and underwent successful surgery (group 3) and two infants (1.9%) were lost to follow up. Conclusion: New risk stratification during the COVID-19 pandemic was an efficient and safe strategy in managing low-risk ROP babies.

Interventions to Improve Patient Safety During the Covid-19 Pandemic: A Systematic Review

“…Studies also examined redesign/reorganization [32][33][34][35] , prioritization protocols 36 and pivot plans for resumption of services 37 . Examples of studies which utilized risk stratification 38,39 and information technology strategies 7,28,42 includes testing protocols based on guidelines and input from interdepartmental team members 40,41 . One study created a protocol for international medical missions to mitigate exposure and transmission risk and implemented telemedicine, education, and modified procedures in alternative follow-up protocols 42 .…”

“…A unique, pharmacologic approach to stress testing 18 was used to improve diagnostic safety. Novel guidelines were implemented across four studies spanning pressure injuries and falls 58 and surgical safety 30,36,38 , and using a pivot plan 37 to allow resumption of elective surgeries. The pivot plan was developed to help find safe pathways for elective surgeries during a pandemic, and consisted of guidance to support a resumption of services across procedural areas.…”

“…Within medication safety, one study noted above used WhatsApp to share prescribing error scenarios among community pharmacists 13 while another evaluated the use of data-based software to check for Drug-Drug Interactions 14 . The three surgical safety studies creating modified risk-scoring 38,68 along with defined selection criteria 34 to determine candidacy for surgery.…”