A randomised quality improvement trial tested something administrative rather than clinical: placing teleretinal screening orders in bulk for every eligible patient on a list, instead of relying on the order being raised at an individual visit.
Across 5,665 eligible patients, six-month screening completion was 17.5%. Receiving a bulk order raised the odds of completion by 78%. Just under half the patients opened the accompanying electronic message, and opening it raised completion by a further 8.5 percentage points and scheduled fundus photography appointments by 19.1 points.
The number that should stop a reader is the baseline. Even with the intervention, fewer than one in five eligible patients completed screening within six months. This is a real improvement on a very poor starting point, not a solved problem.
What makes it a pearl is that it needs no clinical decision and no new equipment. The order can be raised for a cohort rather than a person, and the constraint it removes — that someone must remember during a consultation — is the one that actually limits screening rates.
- Raise retinal screening orders for the eligible list, not only at the consultation.
- Pair the order with a patient message: opening it was worth another 8.5 points of completion.
- Measure completion at six months, not orders placed — the gap between them is the whole problem.
- Expect the absolute rate to stay low; this improves a poor baseline rather than fixing it.
The statistics, in plain English
An odds ratio of 1.78 with an interval of 1.49 to 2.14 is a clear effect, but odds ratios overstate how big a change feels when the outcome is common, so the percentage-point figures are the ones to quote: 8.5 points more completion, 19.1 points more appointments scheduled. This was a randomised quality improvement trial, which is stronger than a before-and-after comparison because secular trends and seasonal effects hit both arms. The important caveat is the ceiling: 17.5% completion overall means the intervention moved a badly broken process a little, and the remaining 82% is not explained by anything measured here.
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