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. 2021 Jan 25:15:289-297.
doi: 10.2147/OPTH.S268190. eCollection 2021.

Cataract Surgery Redesign: Meeting Increasing Demand, Training, Audit and Patient-Centered Care

Kim Lawrence Ah-See  1 , Andrew Blaikie  2 , Natalie Boyle  3 , Jonathan Foulds  3 , Catherine Wheeldon  3 , Peter Wilson  3 , Caroline Styles  3 , Shona Sutherland  3 , Roshini Sanders  3
Affiliations

Cataract Surgery Redesign: Meeting Increasing Demand, Training, Audit and Patient-Centered Care

Kim Lawrence Ah-See et al. Clin Ophthalmol. .

Abstract

Objective: The demand for cataract surgery in Fife (a well-defined region in southeast Scotland) was steadily increasing over 15 years. Cataract surgery was therefore being outsourced to meet demand with consequences on list mix, training needs, patient experience and staff morale. We aimed to redesign our services to meet local demand, retain a patient-centered service and continue to fulfil training needs.

Methods: We quantified cataract surgery delivery over an 18-month period: before, during and after redesign of services. We studied numbers of operations, trainee cases and number of outsourced cases. We also considered the economic implications of the redesign.

Results: We studied three periods (each of six months duration): before redesign (BR), redesign period (RP) and post-redesign (PR). Data were collected on total operation numbers, number of cases performed by trainees, and numbers performed out with normal working hours (weekend lists) and external providers. An economic analysis examined the cost of outsourcing cataracts during BR and RP and the costs of the redesign, including building, equipment and additional nursing staff.

Conclusion: Regional fulfilment of cataract surgery provision remains a continuous challenge within the NHS. We show that with minimal investment, smart redesign process and collaborative working, increased local provision is possible while fulfilling trainee needs and achieving the necessary clinical audits and national standards.

Keywords: cataract surgery; healthcare policy; service provision; training.

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Conflict of interest statement

All authors declare no conflict of interest: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
NHS Fife cataract referral form.
Figure 2
Figure 2
Post-operative visual acuity outcomes for QMH department (all surgeons) compared to Doctor X.
Figure 3
Figure 3
Cataract surgery procedures performed in calendar years 2009 to 2018 by NHS Board in Scotland, United Kingdom. From: Scottish Government. National Ophthalmology Workstream: Hospital Eye Services Progress, Priorities & Practical Actions for a Safe, Sustainable Service across Scotland April 2017.18 Accessible at: https://www.nhshighland.scot.nhs.uk/Services/Optometry/Documents/SGHD%20National%20Ophthalmology%20Workstreams%20HES%20April%202017.pdf.
See this image and copyright information in PMC

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