AT A GLANCE
THE CHALLENGE
Ophthalmic services were facing significant pressures due to the impact of COVID-19, workforce challenges and an ageing population. Demand was outstripping capacity, leading to long waits for consultations and surgery.
The number of weekly appointments for the cataracts assessment clinic was inconsistent and 35 patients per week were being sent for private cataract surgery. As Sussex has one of the highest proportions of older people in the country, it can expect to see a significant and ever-increasing demand for eye services.
Variable theatre list planning and surgery protocols and the hospital’s physical lay-out, without a structured day case area, were all hampering efforts to tackle the pandemic backlog.
WHAT WE DID
The CLEAR team made several site visits and conducted remote interviews, clinical observations and documentation reviews. Data was collected on estates, workforce, systems, patient flow and staff perceptions. The team interviewed 40 staff members including nurses, advanced practitioners, ophthalmologists, optometrists, orthoptists, health care assistants, administrators and theatre staff.
CLEAR RECOMMENDATIONS
The national CLEAR team recommended that theatre efficiency could be optimised by using a risk stratification tool to divide cataract patients into three lists – high volume low complexity (HVLC), standard and complex.
Two full-time, dedicated cataract theatres would provide enough capacity to meet demand. A clinical room at Sussex Eye Hospital could be converted to enable cataract surgery. Cataract lists planning could be simplified and a medical documentation assistant employed for administrative work.
A regular number of weekly cataract clinics could be held, meeting the demand for 60 appointments per week and ensuring workforce consistency. A cataracts case manager could be appointed to rebook last-minute cancellations and nurse-led pre-operative clinics set up to allow preparation time for HVLC patients the day before their procedure.
FORECAST IMPACT
The recommendations would result in £1.37m of savings – including £1.1m by reducing cataract lists from 29 to 19 each month and the appropriate stratification of patients – while meeting cataract service demand and clearing the waiting list backlog.
This represents a productivity gain of 2.9% with 19 theatre sessions freed up each week. The savings could be used to fund a proposed new workforce model designed to clear a backlog of more than 7,000 glaucoma patients.
The optimisation, training and development of the workforce would improve staff retention and recruitment.
