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Evening Clinics

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Evening Clinics Who does do all the work? Mr Andrew Plumb Mfazo Hove Claudia Ban
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Page 1: Evening Clinics

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Evening Clinics

Who does do all the work?

Mr Andrew Plumb

Mfazo HoveClaudia Ban

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Introduction

Government target : All new patientsto be seen within 13weeks of referral by March2004.

In the second quarter of 2003 EastSussex Hospitals received 3563 newpatient referrals.

Brighton and Sussex University

hospitals received 2129. Of the 2257 written by GPs 1567

(69.4%) were seen in 13 weeks.

www.doh.gov.uk/waitingtimes/2003/

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A further 205 (9.1%) were seen after 

waiting 13-17 wks and 255 (11.3%)

after 17-21wks.

Clearly to meet the governmenttarget more new patients have to be

seen quickly.

Enter : Evening New Patient Clinics

This would increase our capacity tosee new patients and help

accomplish our target

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Evening Clinics ² The Ethos

Run by Associate Specialistsand Staff Grades

Supposed to be one stop shop

allowing patients to feed intoother existing services

Patients for these clinics areselected specifically

Cost efficient to establish asinfrastructure and staff alreadyexist.

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The Conundrum

Unless all patients seen in the

evening clinics are discharged, their 

addition to the various waiting listsmust create more work and longer 

waiting lists.

How much more work & for whom?

Are we providing a better service for 

our patients?

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The audit - method

´Retrospective reviewµ of current practice as opposed to

true audit. Identified first 10 evening

clinics

Traced available case notesfrom these clinics

Reviewed case notes.

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Results

63 sets of notes reviewed out of apossible 100.

All available notes were reviewed. 11 patients did not attend their 

appointments. Higher rates of DNAspossibly due to time of appointment.

Lots of patients requested re-scheduling of appointments to avoidevening clinic.

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Diagnoses

0

2

4

6

8

10

12

1416

18

      C    a     t    a    r    a    c     t

     N     A     D

     M    e     i     b    o    m     i    a    n

     A     R     M     D

     A    m     b    y     l    o    p     i    a

     D     i    a     b    e     t     i    c

     P    o    s     t    e    r     i    o    r

     B      C      C

Series1

Other diagnoses: (n=1 each)

Dry eyes, Trichiasis, Congenital Toxoplasmosis, Entropion,

Choroidal naevus, Ectropion, Glaucoma, Scotoma,

Keratoconus, Congenital cataract, Tear film instability,

Cluster headaches, Stenosed puncti, Xanthelasma,Concretions, Blepharitis,

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Procedures generated

02468

101214

161820

   C   a   t   a   r   a

   c   t

   Y   a   g   c   a   p   s  u   l   o   t   o   m

  y

   L   a   s   e   r

   T   r   i   c   h   i   a   b   l   a   t   i   o   n

   M   i   n   o   r   o   p

   B   C   C

   e  x   c   i   s   i   o

   n

Cataract

3 snip

Yag capsulotomy

Entropion Correction

Laser Trichiablation

Removal/curretage of cysts

Minor op

Ectropion Correction

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Followups generated

0

5

10

15

20

25

30

  M e d  i c  a

  l   C  l  i  n  i

  O  r  t  h

 o  p  t  i  s  t  s

  L o  w   v  i  s  u

  a  l   a  i

  C  a  s  u

  a  l  t  y

  P  h o  t o g  r  a  p  h

   V  i  s  u

  a  l   f  i e  l d

  C o  n  t  a c  t   l e  n  s 

 c  l  i  n

Medical Clinic

Orthoptists

Low visual aid

Casualty

Photography

Visual fields

Contact lens

clinic

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Discussion

Approximately every threepatients seen in evening clinicgenerates 1 cataract operation,

1 minor operation and 1 generalclinic appointment.

63 patients generated over 100dictated and typed letters.

13 out of 63 patients were seenand discharged on the day of clinic.

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Three of the five orthoptistappointments were double

appointments to assess

diplopia.

The casualty appointments

were as a result of patients who

had minor ops attending for 

complications.

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The Implications

Clearly evening new patient clinicsincrease access to the services providedby the ophthalmology department.

They also increase the amount of work

done by all the staff. This extra work however may adversely

affect performance if the services arealready stretched to capacity.

Achievement of the government target of 

seeing new patients within 13 weeks of referral will involve planning to increasecapacity across the range of staff employed in the department.

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There is currently a huge

backlog of minor ops which

could provide an excellentlearning opportunity for SHOs if 

adequately supervised.

Training of nurses to do IOPscould potentially increase

capacity in general clinics.


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