Huw Jenkins Consultant Ophthalmologist Aims Streamline HDUHB Cataract service as per Wales Cataract pathway Establish continuous Audit of Outcomes Introduce an integrated cataract pathway booklet ID: 1041945
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1. Pilot study – experience with new integrated Cataract pathwayHuw JenkinsConsultant Ophthalmologist
2. AimsStreamline HDUHB Cataract service (as per Wales Cataract pathway)Establish continuous Audit of OutcomesIntroduce an integrated cataract pathway booklet
3. Step 1Discharge all routine 1st and 2nd eyes direct to EHEW accredited optometrist from theatre N= 289 (HJ lists from 22nd Feb. – 12th Sept. 2016)supplyPatient explanation letterList of local EHEW practices HDUHB Post-op Cataract report formPre-paid return addressed envelope
4. HDUHB Report Target refractionVisual outcomesSatisfaction measuresDesire for 2nd eye surgery?
5. Report Return rates
6. Average return (Feb-June 2016)Why not 100% return?? Report lost ? Not seen? Non-EHEW r/v? Happy with unaided vision? Problems(Reasons under investigation)
7. Visual Acuity (BCVA), N=1376/12 (or better) 94.2% 6/9 (or better) 89.1% 6/6 (or better) 51.8%Comparison with studies: ≥6/12 UK NCS 86% S NCR 84% UK CND 91%
8. Cumulative Refraction Accuracy, N=1341.0D (or better) 90.3% 0.50D (or better) 70.1%Royal College of Ophthalmology Guidelines (2010)1.0D target 85% 0.5D target 55%
9. Refraction Accuracy Spread
10. Refraction Accuracy
11. Satisfaction measuresCompared with before surgery, what does the patient think of vision in the operated eye?ImprovedNo changeWorse9631
12. Satisfaction measuresOverall, how does the patient feel about the cataract operation?SatisfiedNeither Satisfied or dissatisfiedDissatisfied9451
13. Second eye surgery?If this is first procedure, does patient wish to be listed for surgery to 2nd eye?YesNo N/ANo answer6410251
14. Conclusions – step 1 Patients satisfied with processImproved collection of outcome measures289 “extra” HES clinic spaces createdBetter communicationNeed to increase return rate to 100%
15. Other problems….
16. Pre-op ward rounds…...
17. Step 2Introduce an integrated “self contained” multidisciplinary cataract pathway bookletAll necessary information bound in one document
18. ContentsPatient profile Visual historyMedical HistoryMedication problemsStandardised history & examination sectionRisk factorsWarfarinAlpha blockersRefractive aimsIOL choice ConsentBiometry (plus guide)Nursing pre-assessmentAdmission checklistTheatre checklistWHO Cataract safety checklistOp noteDischarge care plan Post-op ReportOutcome
19. Benefits to integrated pathway
20. Conclusions / plansNeeds administrative support (co-ordinator)Needs independent audit supportNeeds EPR system to feed into national dataset (awaiting Medisoft®)Continue to upscale projectAwaiting bilingual documents