1. PEARS/MECS ANNUAL UPDATE
6/7/16

2. We Are On A Mission To prove our service To care for Px
To drive up standards

3. Mini-CG Review Using March & May figures
Looking carefully at practices that stood out last time
Or are doing large numbers
Or have become outliers

4. Mini-CG Review We do not seek to pick on anyone
If you are an outlier we have to act
We expect some behaviours to change following this exercise

5. Mini-CG Review
Letters sent
Practice visits planned

6. PEARS/MECS Activity

7. Activity By Practice

10. Discharged (avg 63%)

11. Follow Ups (avg 14%)

12. 24 Hour ARC Referral (avg 6%)

13. 72 Hour ARC Referral (avg 5%)

14. IOPRM & Cataract

15. IOPRM & Cataract The ‘ugly sisters’ Minor increases in users
If you benefit from PEARS/MECS we expect you to join, support and use the other services as well

16. PEARS/MECS…Doing Things Better

17. Use the Guidance

18. Use the Guidance

19. Use the Guidance

20. Use the Guidance

21. Use the Guidance

22. Use the Rules

23. Use the Rules

24. Use the Rules

25. Use the Rules

26. Use the Rules

27. Use the Rules

28. PEARS/MECS Data Quality of Record Keeping Clear Contemporaneous
Concise
Relevant
Reason for referral
Completion

29. Using the software Unprecedented level of accuracy
Use specific cases as examples
Show the level of data we can accumulate
Confused symptoms, notes referrals.
Signs & clinical findings in appropriate box
Discussion not lecture
Follow ups …..another ugly sister?
Of 1153 follow ups to date, 89% have not been recorded

30. Quality of Clinical Notes using a series of real referrals from the service

31. 24Hr Referral – poor notes
Reason for Referral (Triage)
FnF
Eye Examination Notes (Consultation)
Comments (Consultation)
“ _”
Comments (Outcome)
“_”

32. 72 Hour Referral – poor notes
Reason for Referral (Triage)
Other
Eye Examination Notes (Consultation)
flashes in both eyes LR. When px moves eyes
Comments (Consultation)
“ _”
Comments (Outcome)
“_”

33. 24Hr Referral poor notes Reason for Referral (Triage)
Painful eye
Eye Examination Notes (Consultation)
Painful red eye
Comments (Consultation)
“Painful red eye emergency referral”
Comments (Outcome)
“Painful red eye”

34. 24Hr Referral poor notes Reason for Referral (Triage)
Other
Eye Examination Notes (Consultation)
drop in vision
Comments (Consultation)
“drop in vision”
Comments (Outcome)
“_”

35. 24Hr Referral – good referral, poor notes
Reason for Referral (Triage)
Other
Eye Examination Notes (Consultation)
Flashes and Shadow in RE
Comments (Consultation)
“Flashes and Shadow in RE”
Comments (Outcome)
“_”
@WEI
Vitreous haemorrhage

36. 24Hr Referral poor notes Reason for Referral (Triage)
Red eye
Eye Examination Notes (Consultation)
Px has reported a Red swollen eye
Comments (Consultation)
“RE - Redness / swollen and watery discharge”
Comments (Outcome)
“_”

37. Quality of Decisions

38. Reason for Referral (Triage) Eye Examination Notes (Consultation)
Painful eye
Eye Examination Notes (Consultation)
fb from strimmer yesterday
Comments (Consultation)
“central corneal abrasion”
Comments (Outcome)
“corneal abrasion yesterday. px feels the ey is worse today. stains readily. No evidence of foreign body remaining.”
Action
24 hr referral WAS IT REALLY NEEDED?

39. Reason for Referral (Triage)
F&F
Eye Examination Notes (Consultation)
RE Shadow and pain
Comments (Consultation)
Comments (Outcome)
“_”
Referral
Urgent 72 hour for F&F
@WEI
Seen next day A&E; grade 3+ AC cells; treated for iritis, referred to ARC CONFUSED MECS REFERRAL

40. Reason for Referral (Triage) Eye Examination Notes (Consultation)
sore eyes
Eye Examination Notes (Consultation)
Swollen, itchy, watery and sore red eyes
Comments (Consultation)
Diagnosis Allergy
Outcome
Urgent 24 hr referral
WAS IT REALLY NEEDED?

41. Reason for Referral (Triage) Eye Examination Notes (Consultation)
red eye
Eye Examination Notes (Consultation)
Px reports she has a stye LE 2/7 ago, eyes
were stuck together this morning becoming more painful as the day goes on. Px pregnant due soon.
Comments (Consultation)
Diagnosis Stye
Outcome
Urgent 24 hr referral
WAS IT REALLY NEEDED?

42. Reason for Referral (Triage) Eye Examination Notes (Consultation)
red eye
Eye Examination Notes (Consultation)
LE outer corner of lid inflamed and sore itchy patches.
Comments (Consultation)
Diagnosis other
Outcome
Urgent 72 hr referral
WAS IT REALLY NEEDED?

43. Reason for Referral (Triage) Eye Examination Notes (Consultation)
red eye
Eye Examination Notes (Consultation)
Increase in itching, red, watery, sticky eye
Diagnosis
Bacterial conjunctivitis
Outcome
Urgent 72 hr referral
WAS IT REALLY NEEDED?

44. Mrs W Triage Consultation Notes Diagnosis Referral ARC 72 hrs
Loss of Vision
Consultation Notes
macular haemorrhage
Diagnosis
wet AMD
Referral
ARC 72 hrs
APPROPRIATE PATHWAY?

45. Mrs LM Triage Consultation Notes Diagnosis Referral ARC 24 hrs
Loss of Vision
Consultation Notes
Pain inside and back of LE. Last month dry eye drops
Diagnosis
unknown pain
Referral
ARC 24 hrs
WAS IT REALLY NEEDED?

46. Mr G – good referral. Wrong time frame
Reason for Referral (Triage)
F&F
Eye Examination Notes (Consultation)
F&F 3 days
Temporal RD with macula off, VA 6/36
Referral
ARC 72 hrs
Outcome
attended A&E, surgery next day, VA 6/9-

47. Mr TG -good referral Triage Consultation Notes Referral Outcome
F&F
Consultation Notes
26/1/16 – F&F, RD
Referral
ARC 24 hrs
Outcome
operated 1/2/16, now has cataract

48. Mrs FF – good referral, wrong time frame
Triage
F&F
Consultation Notes
bilateral disc swelling
Comments
Papilloedema
Referral
ARC 72 hrs

49. Does the referral system work?
or print & walk in?
Phoning ARC?
Triage in ARC?
Referral replies

50. PEARS…MECS
Patients already under HES for that condition

51. Pharmacies
Pharmacies
3 day limit on Rxs

52. PoLCV

53. Success rate of Cataract Referrals at WEI 12th April 2016
PRAB BOPARAI BSc (Hons) MCOptom
Hospital and Community Optometrist
Co-Chair (Wolverhampton Local Optometric Committee)

54. Results - Mode of referrals
Most referrals received via GOS 18,
Next popular mode was new cataract pathway followed closely by the old pathway. (Combined almost half referrals coming in via the pathway)
Mode of Referral
Referrals (98)
GOS 18 34
New Cataract Pathway 23
Old Cataract pathways 21 GP 12
Others 8

55. Success rate of total referrals
Unsuccessful > 9 = Incorrect referrals (insig cat, VA better than 6/12)
9 = Other pathology ( referral for ^IOPs or corneal or macular pathology) OR at times a non-specific referral was triaged into cataract clinic.
4 = px declined
5 = other (pending - eg px has dementia - needed to check with guardian, or px to think about it)
Outcome
Referrals
(98)
Successful 71
Unsuccessful 27

56. Success rate distribution
Mode of referral
Successful (71)
GOS 18 21
Old Cataract Pathway 18
New Cataract Pathway 17
Others 8 GP 7

57. Success of modes of referral

58. Conclusion
72% of all referrals to cataract clinic resulted in listing for surgery
74% of referrals from new cataract pathway and
86% of referrals from “old” cataract pathway listed for surgery
58% from GP and
62% from GOS 18 resulted in surgery
Reasons for patients not being listed for surgery:
DNA (13/111……….>10%)
Incorrect referral
Wrongly booked patient /other pathology
72% of total cataract referrals coming into cataract pre-assessment are successfully converted into surgery.
Incorrect referral – cataract not significant or good VA > so should not have come into hospital -
Wrong clinic – non-specific referral triaged into cataract clinic > New improved eGOS18 to have a tick box for which clinic

59. Recommendations
Encourage increased uptake of cataract pathway referrals
Reduce GOS18 referrals
Encourage GPs to use Optometrists for cataract referrals using pathway
Encourage feedback to referring Optometrist

60. Food for thought
23 referrals came via GOS18 from practices on cataract pathway - why? Unclear referral?
14 (61%) successful for surgery
9 (39%) unsuccessful for surgery
7/98 Optom / practice details illegible

61. Enrol onto cataract Pathway
Get £35 for a dilated exam
Patient completes questionnaire
Easy to enter onto Optomanager
Refined referral
Gain respect from patient AND Hospital
Referral ed so can’t get lost
ed direct to hospital so quicker for patient
WHY SAY NO !!!