PaeDIATRIC Ophthalmology PRIORITY CONSULATION CLINIC A quality improvement initiative in paediatric eye care in Northern Ireland Dr Marie ONeill MRCOphth Associate Specialist Presented on behalf of the Paediatric Ophthalmology Team, Belfast Trust

THE story – the part I played and what I have learnt! Paediatric Ophthalmology Team, Belfast Trust Clinical Lead Miss E McLoone, Miss S George, Mr M OGallagher, Consultants Dr R Gamble SD SN J Kearney SN S Hutchinson and Nursing team Orthoptic team, Optometric team. Imaging team .Clerical team. Appointments team and ECLO support

“Open your eyes, train your ears and use your head” outline my background POPCC conceived POPCC develops The team approach Unexpected bonuses “Open your eyes, train your ears and use your head” - Haruki Murakami

My Background Qualified 1983 Ophthalmology 1986 Clinical medical officer 1989 – outpatient sessions Eye casualty, general clinics, community paediatric ophthalmology Regraded Associate Specialist 2011 2013 recruited to establish new urgent access paediatric service

My Skill set versus Huge variation of management Children with no acute problems are being over investigated Those with problems are being missed

My Skill set 24 years experience at managing casualty patients Introduced first paperless Eye A&E system in UK Practical pragmatic generalist and optimist Enjoy challenging work and problem solving Great belief in the team based approach Enjoy teaching and mentoring trainees and nurses

My skill set “Things don’t have to be this way!”

Acute Problems 2013 Paediatric service Urgent children sent to busy adult A&E 1000 per year office hours Long waiting times Anxious parents Fractious children Often seen by trainee High ‘referral on’ rate ‘Nightmare’ for parents Acute Problems 2013 Paediatric service

Follow up - Problems 2013 Children added into already over stretched clinics Exam difficult as already traumatised by casualty visit Challenging patients Stressed parents Time pressures at overbooked clinic Often booked back for further investigations Clinician under pressure to counsel parents effectively Breaking bad news under difficult circumstances

POPCC conceived Eibhlin McLoone, consultant lead Problems identified Solution suggested My skill set matched role of developer and clinician needed

Goal A novel, high quality, flexible specialist clinic to improve the delivery of urgent ophthalmic care to the children of Northern Ireland To ensure that each child received the right care, at the right place with the right person

TRIAGE – Key Electronic triage using a generic email address Triage team, one nurse and 3 senior ophthalmologists

Dedicated clinic slots Emails triaged and allocated clinic slots from POPCC electronic diary 4 slots within each paediatric clinic, booked only by POPCC triager Dynamic response to urgency of referral Team based approach One stop shop

POPCC grows 2013 – 12 appointments weekly 2016 – 19 2017 – 24 40% discharge rate

POPCC Referrals

POPCC No. of Audit forms processed 2015 (N=689)

The Team approach Child booked to appropriate clinic setting Truly multidisciplinary team approach, from secretary ringing parent to make appointment booking to child leaving clinic with managed outcome Nursing role expanded Team mobile Team meetings

Unexpected bonuses Monitoring trends Pathway for managing suspicious discs, one stop visit

Identifying public health issues

Unexpected Bonuses Closely knit team Encouraging each other to broaden our skills and develop confidence Supporting each other in managing our complex challenging patients

et PO Paediatric Ophthalmology Priority Consultation Clinic

THANKS To all the team