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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.