1. Pilot study – experience with new integrated Cataract pathway
Huw Jenkins
Consultant Ophthalmologist

2. Aims Streamline HDUHB Cataract service (as per Wales Cataract pathway)
Establish continuous Audit of Outcomes
Introduce an integrated cataract pathway booklet

3. Step 1
Discharge all routine 1st and 2nd eyes direct to EHEW accredited optometrist from theatre
N= (HJ lists from 22nd Feb. – 12th Sept. 2016)
supply
Patient explanation letter
List of local EHEW practices
HDUHB Post-op Cataract report form
Pre-paid return addressed envelope

4. HDUHB Report Target refraction Visual outcomes Satisfaction measures
Desire for 2nd eye surgery?

5. Report Return rates

6. Average return (Feb-June 2016)
Why not 100% return?
? Report lost
? Not seen
? Non-EHEW r/v
? Happy with unaided vision
? Problems
(Reasons under investigation)

7. Visual Acuity (BCVA), N=137
6/12 (or better) 94.2% 6/9 (or better) 89.1% 6/6 (or better) 51.8% Comparison with studies: ≥6/12 UK NCS 86% S NCR 84% UK CND 91%

8. Cumulative Refraction Accuracy, N=134
1.0D (or better) 90.3% D (or better) 70.1%
Royal College of Ophthalmology Guidelines (2010)
1.0D target 85% D target 55%

9. Refraction Accuracy Spread

10. Refraction Accuracy

11. Satisfaction measures
Compared with before surgery, what does the patient think of vision in the operated eye?
Improved
No change
Worse 96 3 1

12. Satisfaction measures
Overall, how does the patient feel about the cataract operation?
Satisfied
Neither Satisfied or dissatisfied
Dissatisfied 94 5 1

13. Second eye surgery?
If this is first procedure, does patient wish to be listed for surgery to 2nd eye?
Yes No
N/A
No answer 64 10 25 1

14. Conclusions – step 1 Patients satisfied with process
Improved collection of outcome measures
289 “extra” HES clinic spaces created
Better communication
Need to increase return rate to 100%

15. Other problems….

16. Pre-op ward rounds…...

17. Step 2
Introduce an integrated “self contained” multidisciplinary cataract pathway booklet
All necessary information bound in one document

18. Contents Patient profile Standardised history & examination section
Visual history
Medical History
Medication
problems
Standardised history & examination section
Risk factors
Warfarin
Alpha blockers
Refractive aims
IOL choice
Consent
Biometry (plus guide)
Nursing pre-assessment
Admission checklist
Theatre checklist
WHO Cataract safety checklist
Op note
Discharge care plan
Post-op Report
Outcome

19. Benefits to integrated pathway
Cataract clinic
Efficiency
Standardised
Nurse led/ supported clinics
One stop
Numbers
Surgery
Safety
Avoid cancellation
Reduce stress
Reduce unnecessary work
Higher throughput
Outcome measures
Essential part of practice
Revalidation
National Dataset

20. Conclusions / plans Needs administrative support (co-ordinator)
Needs independent audit support
Needs EPR system to feed into national dataset (awaiting Medisoft®)
Continue to upscale project
Awaiting bilingual documents