Transformational change in care pathways & the impact on service outcomes post Covid-19 pandemic
Main Article Content
Abstract
Background: COVID-19 caused disarray in global healthcare systems. Ophthalmology elective outpatient services which accounts for 10% of all hospital outpatient services were shutdown resulting in a significant backlog of patients with sight threatening consequences. Vulnerabilities within our healthcare systems were brought to light, demonstrating the need for transformational change in the delivery of care. Worcestershire Acute Hospitals NHS trust established first diagnostic hubs in Midlands for ophthalmic service to restructure its ophthalmology service delivery using the Covid-19 special funding. There is paucity of data on the efficacy of setting up diagnostic hubs in ophthalmology delivering efficient virtual clinics in glaucoma service.
Aim: To assess the impact of diagnostic hub by measuring the slippage in follow up appointments after setting up the diagnostic hub & virtual glaucoma service after pandemic in July 2020
Methods: This is an observational study comparing delays in follow up appointments before Covid-19 and post-Covid-19 set up of a diagnostic hub for data collection and enhanced use of the virtual clinics in glaucoma service at Worcestershire Acute Hospitals NHS Trust. We compared the Slippage (delay beyond the clinically suggested interval) in follow up appointments and stability of visual fields to assess the efficacy of a diagnostic hub and new virtual clinic service.
Result: The slippage of more than 3 months in appointment has reduced from 94% in 2020 to 20% in 2023. The visual field stability had significantly improved to 89.8% in 2023 from just 2% in 2020. This significant improvement is a direct result of setting up of diagnostic hub delivering efficient virtual glaucoma service
Conclusion: This study clearly demonstrates the positive impact of transformational change in healthcare delivery by setting up a diagnostic hub for ophthalmology. This study supports that building this capacity is important to reduce how long people are waiting for treatment. The reduced delay in treatment has led to improved clinical outcomes.
Article Details
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References
2. Stoye G, Warner M, Zaranko B. Could NHS waiting lists really reach 13 million? The Institute of Fiscal Studies; 2021. Accessed 02/09/2021 via URL, https://ifs.org.uk/ publications/15557.
3. 40 community diagnostic centres launching across England.
https://www.gov.uk/government/news/40-community-diagnostic-centres-launching-across-england
4. https://www.england.nhs.uk/wp-content/uploads/2020/10/BM2025Pu-item-5-diagnostics-capacity.pdf
5. Resnikoff SFW, Gauthier TM, Spivey B (2012) The number of ophthalmologists in practice and training worldwide: A growing gap despite more than 200,000 practitioners. Br J Ophthalmol 96(6): 783-787.
6. Batra R, Sharma HE, Elaraoud I, Mohamed S (2018) Resource planning in glaucoma: A tool to evaluate glaucoma service capacity. Semin Ophthalmol 33(6): 733-738.
7. Foot, B., MacEwen, C. Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome. Eye 31, 771–775 (2017). https://doi.org/10.1038/eye.2017.1
8. Tatham A, Murdoch I. The effect of appointment rescheduling on monitoring interval and patient attendance in the glaucoma outpatient clinic. Eye (Lond). 2012 May;26(5):729-33. doi: 10.1038/eye.2012.22. Epub 2012 Mar 2. PMID: 22388592; PMCID: PMC3351056.
9. Womach S. Optitians-blame-patients-loss-of-sight-on-targets: http://www.telegraph.co.uk/news/uknews/1437054
10. Evans JR, Fletcher AE, Wormald RP. Depression and anxiety in visually impaired older people. Ophthalmology 2007; 114 (2): 283–288.
11. Cox A, Blaikie A, Macewen CJ, Jones D, Thompson K, Holding D, Sharma T, Miller S, Dobson S, Sanders R. Optometric and ophthalmic contact in elderly hip fracture patients with visual impairment. Ophthalmic Physiol Opt. 2005 Jul; 25(4):357-62.
12. Dhital A, Pey T, Stanford MR . Visual loss and falls: a review. Eye 2010; 24: 1437–1446.
13. https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis
14. Szegedi S, Ebner C, Miháltz K, Wachter T, Vécsei-Marlovits PV. Long-term impact of delayed follow-up due to COVID-19 lockdown on patients with neovascular age-related macular degeneration. BMC Ophthalmol. 2022 May 20;22(1):228. doi: 10.1186/s12886-022-02453-4. PMID: 35596203; PMCID: PMC9122252.
15. Department of Health and Social Care. 40 Community Diagnostic Centres Launching Across England (2021). Available from:
https://www.gov.uk/government/news/40-community-diagnostic-centres-launching-across-england
16. Wale A, Okolie C, Everitt J, Hookway A, Shaw H, Little K, Lewis R, Cooper A, Edwards A. The Effectiveness and Cost-Effectiveness of Community Diagnostic Centres: A Rapid Review. Int J Public Health. 2024 Jan 23;69:1606243. doi: 10.3389/ijph .2024.1606243. PMID: 38322307; PMCID: PMC10844947.
17. NHS England. Diagnostic: Recovery and Renewal. Report of the Independent Review of Diagnostic Services for NHS England (2020). Available from: https://www.england.nhs.uk/wp-content/uploads/2020/11/diagnostics-recovery-and-renewal-independent-review-of-diagnostic-services-for-nhs-england-2.pdf
18. The King’s Fund. Are Community Diagnostic Centres Really Moving Care Closer to Home? (2022). Available from:
https://www.kingsfund.org.uk/blog/2022/10/are-community-diagnostic-centres-really-moving-care-closer-home (Accessed November 03, 2022).