Introducing the ‘Benign Eyelid Lesion Pathway’: 1 year experience of hybrid asynchronous-synchronous tele-oculoplastics in a tertiary hospital

Abstract

Purpose : As demand for eye services is projected to rise by 30-40% in the next two decades, long-term solutions must be sought to continue to provide quality care. Telemedicine is an option for specialities reliant on history and observation, such as Oculoplastics, of which benign eyelid lesions make up most referrals. We undertook a retrospective analysis of 974 patients referred for benign eyelid lesions to our tele-oculoplastic clinic. By assessing the efficacy of a hybrid synchronous-asynchronous teleconsultation model, we describe a new streamlined approach to our Benign Eye Lesion Pathway (BELP).

Methods : We retrospectively collected data from ‘OpenEyes’ electronic patient records for patients who went through the BELP service from July 2020 to July 2021. Patients sent from primary care with benign lid lesions were booked to a live video-consultation using ‘Attend Anywhere’. Prior to this, they completed an online questionnaire and uploaded a photograph of the lesion. Patients requiring minor surgery were booked in during the video consultation and consented virtually. We assessed time efficiency, accessibility, affordability and theatre utilisation of the BELP service. To analyse safety, 50 discharged patients were monitored in surveillance clinic to ensure correct diagnosis and management.

Results : Of 974 patients, 558 (57.2%) were listed for surgical procedure from virtual assessment, 232 (23.8%) were discharged and 180 (18.5%) required follow up. Of those requiring follow up, 65 (36.1%) were booked face-to-face and the remainder virtually. The DNA rate was 2.57%, compared with an average of 8.7% for first face-to-face outpatient appointments. Theatre utilisation was efficient, with only 36 (5%) of the patients listed for surgery not proceeding on the day. 58.6% of diagnoses made virtually were accurate with histological findings. No cases deemed benign on remote assessment came back atypical or malignant. There was no significant change in management plan in any case.

Conclusions : The BELP service is a safe alternative to face-to face consultation, leading to efficient theatre utilisation, reduced cancellations, and elimination of travel time and cost for the patient. If clinician satisfaction and issues regarding accessibility to digital infrastructure are explored, telemedicine could be an effective service for the non-urgent biopsy pathway.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.