In a swift response to increasing numbers of patients with ophthalmic disease, we supported Doncaster and Bassetlaw Teaching Hospital with the successful design and delivery of a virtual glaucoma service, enhancing efficiency and patient throughput.

Background

In response to the continued operational pressures in elective care and following the success of the national 100-day challenges, NHS England commissioned NHS Midlands and Lancashire’s Improvement Unit to deliver a wave of rapid improvement challenges across the North Region. We supported Doncaster and Bassetlaw Teaching Hospitals (DBTH) to utilise the 100-day challenge methodology to design and introduce a virtual glaucoma service.​

The number of patients with ophthalmic disease is growing across the UK due to an aging demographic, but growth in the number of ophthalmologists and other resources available to treat those patients has not been commensurate. There is, therefore, an urgent need for a different way of working, particularly in delivering glaucoma services. ​

Also, of the new patients referred to a hospital eye service (HES) with suspected glaucoma or ocular hypertension, typically at least 65 per cent are found to have no pathology requiring further HES intervention and can be discharged back into the community for routine screening. These national trends are mirrored within the HES at DBTH.​

Action

We supported design and development of a virtual glaucoma clinic within the HES at DBTH with all clinical investigations being undertaken by a trained health care practitioner (HCP) and the results or captured data being reviewed virtually by an ophthalmologist at a defined later time. ​

This involved:​

• production of standard operating procedures for the service​
• a pilot clinic and review session​
• a skill mix review of DBTH HES support staff & recruit to resulting deficit via business case ​
• formal job planning of virtual review sessions for ophthalmologists​
• building clinics and integrating as a substantive pathway within DBTH HES.​

Impact

Efficiency and throughput were increased. Patients have a shorter wait for assessment and those with no further clinical needs can be discharged back to community services without a face-to-face clinical consultation with an ophthalmologist. ​

The virtual clinic also enables stable or low risk follow-up glaucoma or ocular hypertension patients (either with or without ongoing treatment) to be remotely monitored before an eventual discharge to community follow-up. ​

Further information

If you would like more information about our services, you can contact us on mlcsu.improvement@nhs.net