The Cataract team in Ophthalmology were keen to look at the patient pathway to see what improvements could be made. Initially meeting in March 2014, the team have continued to meet bi-weekly using the clinical microsystems approach to test changes and make improvements.
The Initial data indicated:
High levels of patient satisfaction with the service, with some concerns about waiting times for surgery and the number of attendances before surgery. Pooling of patients increased the chance of on-day cancellation. Variability in throughput on theatre lists – with 5, 6 or 7 cases taking place (average 5.5) At the time of the assessment the service cost more than the income generated
In addition the team visited a cataract treatment centre in Sunderland to learn about the approaches they had taken to managing the patient journey, this visit proved really useful in helping generate ideas and tests of change in Sheffield.
From meeting, discussing the data and the external visit the team began to think about different trials for the service. The work focused in several areas of the cataract service:
Outpatients – The team focused on ensuring all the relevant preparation for surgery took place at outpatients including the consent process. This would ensure that the patient would not need to be re-consented on the day of surgery.
Pre-assessment – The team incorporated pre-operative assessment into the outpatient clinic, thus enabling the patient to leave outpatients and be ready for surgery without having to attend another appointment.
In addition the team reduced unnecessary questions in the pre-operative assessment and were able to design a new process of taking some information over the phone from patients before attendance at hospital. Patients were also given drops from the outpatient appointment to dilate the eye at home prior to attending, to reduce the time spent waiting in hospital.
Theatre – the team created a new process where patients move through the theatre environment through a series of rooms (examination, anaesthetic, theatre, recovery, and discharge) supported by the same nurse throughout the process (rather than having multiple handoffs).
To date there have been several trials that have taken place with 2 Cataract Surgeons.
One-stop clinics – these enable patients to have one combined outpatient and pre-operative attendance instead of two visits. Patient are given dilating drops to take at home on the day of surgery. Consent now takes place within the one-stop clinic (rather than on the day of surgery) so increases time available for operating
Day of surgery – The one-stop clinic process and the self-dilating drops have supported the new theatre model where patients flow through the unit room by room. This enabled trial lists to have 7, 8 and 10 patients on them, in the same time that commonly enabled 5 or 6 operations to take place. Patients spent around 80 minutes at hospital through the new process, a reduction of 50% on the previous process. Patient feedback indicated they were happy with the service, the one-stop clinic and the new theatre process.
A Business Case for a new Cataract Unit is being prepared and the process designed through the improvement work will be incorporated into the plans for the new unit. It is anticipated that this will be built within the next 2 years. Work will continue between now and then to embed the process with the Surgeons who have trialled so far and spread to any other keen Surgeons.