Tackling the NHS glaucoma clinic backlog issue

Abstract

Background/objectives: to determine whether mass case review, carried out by glaucoma sub-specialist consultants, for patients for whom there was insufficient clinic capacity, could aid reduction of the glaucoma clinic appointment backlog.

Subjects/methods: patient hospital notes were reviewed by a glaucoma fellowship trained consultant and a decision was made as to whether the planned review was appropriate. Decisions were made with respect to timing, clinic-type and necessity for follow-up, together with an assessment as to whether visual field testing was required.

Results: in a 3-year study a total of 9290 cases were included in the study. After consultant review, 5521 (59.5%) patients were kept within the hospital eye service (HES) and an additional 1350 (14.5%) had their next appointment delayed, 384 (4%) were discharged to specialist community glaucoma optometrists and 2035 (22%) were discharged to their standard community optometrists. Overall, therefore 26% of patients were discharged from the HES. Of the planned 9290 appointments, simultaneous visual field testing had been planned for 5393 patients (58%), but after consultant review only 65% (n = 3482) of these were considered necessary, reducing the number of required visual field tests by 35% (n = 1911).

Conclusions: the authors suggest that ophthalmology departments experiencing significant clinic appointment backlog issues, consider utilising trained glaucoma sub-specialist consultants to review planned follow-up management of patients within a backlog deficit.

Fig. 1

A flow-chart showing the decision making pathways in potentially changing the planned follow-up appointment to a more appropriate appointment (ASAP as soon as possible, HES hospital eye service)

Fig. 2

A pie-chart illustrating that although it was suggested that the majority of patients kept their original follow-up appointment (59.5%), after review of the hospital notes, a significant proportion (26%) were discharged from the HES (mainly to a standard community optometrist) or had their HES appointment delayed (14.5%)

Fig. 3

A pie-chart illustrating that of the 58% of patients booked for field tests at follow-up appointments, review of the hospital notes resulted in 35% of the tests being cancelled as unnecessary