A proposed redesign of elective cataract services in Scotland – pilot project

Abstract

Background: The demand for cataract surgery is expected to increase by 25% in the next 10 years as the result of our ageing population. A new pathway is being proposed to improve efficiency by utilising the new General Ophthalmic Services code 2.9 for community optometrists in Scotland for Cataract Referral Refinement and Consenting process. A pilot project has been undertaken at NHS Grampian enabling patients to be assessed and undergo surgery at a single visit to the Eye Outpatient Department. Objectives: To determine the suitability of community cataract referrals for a one stop cataract surgery service and target areas for referral refinement. Methods: 300 consecutive cataract referrals were assessed for suitability for one stop cataract surgery, determined by the documentation of pertinent clinical findings. All suitable referrals were offered a telephone consultation to confirm suitability and those patients were subsequently offered on the day cataract surgery. A telephone led patient satisfaction survey was then completed. Results: 71 (24%) suitable patients were identified from vetting 300 referrals. 54 patients from this group were selected for one-stop service following telephone consultation. 51 patients subsequently attended for surgery. There was a 100% conversion rate to same day surgery and no intraoperative complications reported. Conclusion: The waiting time was significantly reduced, by 30 weeks, for one-stop patients. Approximately one quarter of referrals were deemed suitable for a one-stop service. Many more patients may have been suitable for same day surgery but there was not sufficient information in their referrals to determine their suitability.