1. 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

2. 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

3. “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

4. 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

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

6. 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

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

8. 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

9. 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

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

11. 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

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

14. Dedicated clinic slots
s 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

15. POPCC grows
2013 – 12 appointments weekly 2016 – – 24 40% discharge rate

16. POPCC Referrals

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

18. 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

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

20. Identifying public health issues

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

22. et PO
Paediatric
Ophthalmology
Priority
Consultation
Clinic

23. THANKS To all the team