Title : Optometrist-To-Operation: A proposed redesign of elective cataract services
Abstract:
Objective
A pilot project has been streamlined at NHS Tayside enabling direct-optometrist referral and listing to cataract operation. This study aimed to determine the suitability of this model and target areas for refinement.
Methods
50 patients were invited to this study conducted from December 2022 to February 2023. A package which included 1) Cataract surgery consent form 2) Cataract surgery information leaflet 3) QR code linked to a supplementary patient information video on cataract surgery made by the local cataract team and 4) Questionnaire was mailed to all patients. Patients were then given the options to phone the local ophthalmology department regarding their decisions: 1) Get listed directly for surgery 2) Scheduled for an appointment 3) Refused cataract surgery. Data were also collected on the day of surgery assessing suitability of cataract surgery, accuracy of diagnosis and intraoperative complication rates.
Results
A total of 46 responses were collected (92% response rate). Of these patients, 89% were listed directly on the cataract operation service (n=41/46); 4% (n=2/46) chose to have a telephone appointment prior to surgery and 7% (n=3/46) decided to opt out of the cataract surgery. The predominant reason for not listing was due to patient opted for private healthcare (n=2/3, 67%). The mean waiting times from referral to surgery is 8 weeks (range). X% of patients had cataract surgery on the day of appointment with a X% rate of diagnostic accuracy. All patients were discharged on the same day of surgery with routine optometrist follow up. No intraoperative complications were reported.
Conclusion
Fulfillment of cataract surgery provision remains a continuous challenge within NHS Scotland. Our study shows that with minimal investment, collaborative working with primary care services, and smart redesign process, local provision and access can be possible.
Audience Take Away:
- The demand for cataract surgery in Scotland has steadily increased due to demographic changes, and the impact of COVID-19 has further exacerbated the cataract workflow and waiting list
- A new pathway is being proposed to redesign our local community referral and listing services while retaining a patient-centred service
- Direct optometrist-listing for cataract surgeries (“Optometrist to Operation”) through a streamlined pathway is feasible and benefits patient satisfaction, autonomy, beneficence, and fairness. Optometrists can accurately predict the need for cataract surgery and refer directly to the cataract operation without the need for ophthalmologist involvement, eliminating the need for pre-assessment consultations and streamlining care delivery within the cataract team
