Guidance

Diabetic eye screening: audit schedule

Updated 12 May 2022

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This publication is available at https://www.gov.uk/government/publications/diabetic-eye-screening-audit-schedule/diabetic-eye-screening-audit-schedule

Health equity impact assessment or health equity audit

A health equity impact assessment or health equity audit should be undertaken as part of both the commissioning and review of the screening service, including equality characteristics, socio-economic factors and local vulnerable populations.

This audit is referenced in the service specification.

Frequency

This is recommended as part of the commissioning and reprocurement cycle, or every 3 years.

Excluded and suspended audit

An audit of exclusions should be carried out by the screening service. This audit should include a review of:

  • exclusions by GP practice, and an investigation if practices are reporting unusual levels of exclusions
  • the exclusion process, ensuring all exclusions have adequate supporting documentation
  • the re-invitation process for patients wishing to opt out

This audit is referenced in the:

Frequency

Mandatory: annual.

Recommended: more frequently if required.

Non-responders and DNA audit

  1. An analysis of non-responders and DNAs should be carried out by the screening service with appropriate action to address issues of non-attendance.

  2. The service should report the proportion of people with diabetes not attending an appointment within 3 years, with appropriate actions to identify and implement interventions to address issues of non-attendance.

This audit is referenced in the:

Frequency

  1. Mandatory: 6-monthly minimum

  2. Mandatory: quarterly.

Recommended: annual sample audit from each pathway with results reported to programme board.

Camera image and settings audit

An audit to evidence that regular equipment checks have taken place and appropriate action taken to address issues identified. The audit should make sure that:

  • all equipment the service uses meets national NHS Diabetic Eye Screening Programme guidance
  • each camera used within the service is set at the same or similar settings as every other camera used in the service, within the limitations of the resolution settings available for each camera
  • the resolution is high enough to enable the accurate grading of digital images, in line with national NHS Diabetic Eye Screening Programme guidance

This audit is referenced in the:

Frequency

Recommended: annually.

Grading and ophthalmology outcomes audit

An audit to provide validation of final grades against ophthalmology grades or outcomes provides assurance on the grading quality within the service and makes sure people with retinopathy are in the appropriate care pathway. Results should be presented as part of multidisciplinary team (MDT) meetings.

Even when data is not routinely collected, snapshot audits can provide a good indication as to whether the service is performing well.

Consider the following:

  • ophthalmology outcomes, such as vitrectomy rates, laser book, treatment, and SI and SSI audits
  • audit of people with diabetes presenting with disease to symptomatic services (known or unknown to service)
  • audit of people with a non-referable diabetic retinopathy outcome at last screening presenting symptomatically for treatment within 1 year of the screening episode
  • audit of disagreements with referral outcome grader (ROG) grade as demonstrated by patients discharged back to the service following first visit to hospital eye services (HES)

The audit is referenced in the:

Frequency

Recommended: annually.

10% QA sample

A review of the 10% QA sample which will detect primary level graders who miss features of diabetic retinopathy should be undertaken by the grading leads within the service. Feedback should be provided to graders via 1:1 meetings and annual results reported to programme board.

The audit is referenced in the management of grading guidance.

Frequency

This is a mandatory audit.

Recommended frequency: quarterly.

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