Evaluation of the Manchester COVID-19 Urgent Eyecare Service (CUES)

Abstract

Introduction: Pressure on capacity in ophthalmology alongside the coronavirus (COVID-19) pandemic led to the development of the COVID-19 Urgent Eyecare Service (CUES), allowing patients to receive a prompt ophthalmic consultation, including remotely. The aim of this study was to conduct a service evaluation of CUES in Manchester.

Methods: Data were collected both prospectively and retrospectively from both primary and secondary care over an 8-week period from June to August 2020.

Results: In primary care CUES in Greater Manchester (GM) 2461 patients were assessed, with a majority self-referring to the service (68.7%, n = 1844). 91.7% of cases initially screened for CUES were deemed eligible and given a telemedicine appointment in GM; 53.3% of these cases required face-to-face consultation. 14.3% of cases seen within in GM CUES (351 out of 2461) were provisionally referred to secondary care. Contemporaneously the main provider emergency eyecare department (EED) attendances were reduced by 37.7% per month between April and December 2020 inclusive, compared to the same months in 2019. Patients attending a CUES face-to-face assessment were more likely to have a diagnosis in agreement with secondary care, compared to patients referred in from telemedicine assessment only (P < 0.05).

Conclusion: This evaluation of CUES demonstrates a high level of primary care activity alongside a sustained reduction in EED cases. The case-mix of patients seen within EED following referral appears to be of a less benign nature than those cases seen prior to the introduction of CUES.

Fig. 1. Summary clinical pathway for the Manchester CUES.

F2F: Face to face consultation; GOS: General Ophthalmic Services; Level 2 optometrist has the Independent Prescribing, IP, qualification.

Fig. 2. Flowchart depicting primary care data.

Flowchart depicting primary care data for a GM CUES and b Manchester and Trafford CUES. a A breakdown of the primary care data at each stage for CUES in GM. b A breakdown of the primary care data at each stage for CUES in Manchester and Trafford. *Figures for outcomes of telemedicine assessments may not tally precisely due to selected patients having more than one follow-up appointment post face-to-face assessment or post OCT assessment. CUES COVID-19 Urgent Eyecare Service, GOS General Ophthalmic Services, GP General Practitioner, IP Independent Prescribing, OCT Optical Coherence Tomography, HES Hospital Eyecare Services.

Fig. 3. Flowchart for the pathway of the 98* (of 101) provisional CUES referrals received by MREH EED over the course of an 8-week period between June 2020 and August 2020.

A breakdown of the primary care data at each stage of the process is reflected for Manchester CUES. *3 provisional referral forms could not be attained. CUES COVID-19 Urgent Eyecare Service, DOS Directory of Service, OCT Optical Coherence Tomography, MREH Manchester Royal Eye Hospital, HES Hospital Eyecare Services.

Fig. 4. Graph displaying a summary of the number of MREH EED attendances from 2019 to 2020.

The months of the year are listed on the horizontal axis. The total number of EED attendances is listed on the vertical axis. The percentage change from 2019 to 2020 for each month is displayed. EED: Emergency Eye Department.