1. Reflections and lessons from the Spring round of EQA, 2011
Dr David Cromie

2. The Problem
Picture tells a 1,000 words, and can create thousands of problems.

3. The other problem

4. The risk to patients 3 staff below 70% - from 2 NHS Boards
1 level 2 grader with 60% sensitivity
1,250 screens (since last QA)
referral rate 5%= expected 63 referrals
80% sensitivity ‘miss’ 12 (acceptable)
60% sensitivity ‘miss’ 24
1 Level 1 & 1 level 2 grader from 2nd HB
Emphasis on agreeing a consistent approaches

5. The Response Risk assessment EQA review Other issues Conclusion
Fast grading
Skylight issues
Previous EQA (satisfactory)
Other issues
Conclusion
Need to double check images (both HBs)

6. Outcomes HB A of 1,250 images HB B of ~1,600 images
8 people grading of material difference (expected 12)
Needing referral or 6 monthly review
No sight threatening signs missed
5 telephoned
2 lettered
1 was deceased
No issues
HB B of ~1,600 images
no significant issues identified, process nearing completion

7. The Lessons
Poor grading carries clinical risk of non-referral and blindness
Frequent EQA reduces # of images x 2 checked
EQA needs to be given the same respect as clinical grading
Consider embedding EQA images in normal work flow
Develop agreed response thresholds for level 2 graders <80% sensitivity
Costly to look back: workload implications
Risk to programme reputation: important to resolve
Communication with those involved SGHD, NSD, collaborative leads, other boards
Prepare for release of public information