July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Improving emergency paediatric ophthalmology services at Imperial College NHS Trust; a quality improvement project
Author Affiliations & Notes
  • Caroline Laura Stephanie Kilduff
    Ophthalmology, Royal Free Hospital, London, United Kingdom
  • Siobhan Wren
    Imperial College NHS Healthcare Trust, United Kingdom
  • Footnotes
    Commercial Relationships   Caroline Kilduff, None; Siobhan Wren, None
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3614. doi:
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      Caroline Laura Stephanie Kilduff, Siobhan Wren; Improving emergency paediatric ophthalmology services at Imperial College NHS Trust; a quality improvement project. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3614.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : More than 3000 children attend the eye casualty at Imperial every year. On average, a quarter of attendees require follow up, and a third of these require urgent review by the ophthalmology team, within two weeks. Paediatric ophthalmology services are run across two sites, with diagnostic imaging available at one, and paediatric-trained healthcare staff based at another, and the service falls under two separate funding divisions. Current paediatric ophthalmology clinics are overbooked, with a twelve-week waiting list. The aim of this project was to assess both the cost-effectiveness and safety of the current infrastructure, and use our results to inform improvements to the emergency paediatric ophthalmology service.

Methods : Data regarding children attending casualty was collected over one-month. Data included source of referral and the presenting complaint. For those patients requiring follow up, details regarding location and urgency were noted, as well as the outcome for the patient and whether follow up occurred. The results of the project were presented at the paediatric and surgical joint divisional meeting.

Results : Sixty-nine of the 242 paediatric patients attending casualty required follow up. Of these, 26 required urgent review; 18/69 (26.1%) were referred for review in casualty, and 8/69 (11.6%) to paediatric ophthalmology clinic. The remainder were for routine review. Of these 26 patients, 10/26 (38.5%) either received no review or the review was delayed by more than a month. All of these patients had presented with potentially sight-threatening conditions.

Conclusions : Nearly 40% of children did not receive an urgent review. There is no follow up system for patients who do not re-attend casualty. Furthermore safeguarding opportunities are missed due to lack of continuity of care. According to the National NHS Tariff there was £3,294 lost-income through referrals for review in casualty rather than in specialist clinics. Over one year the £39,528 loss equates to a junior NHS healthcare professional’s salary.
The divisional teams used the results of this project to prioritise the creation of a half-day paediatric ophthalmology emergency clinic. The team have sourced funding, and the location has been approved. Urgent referrals will be triaged by a failsafe officer, and patients reviewed by the dedicated paediatric ophthalmology team.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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