Patient Pathway: OPHTHALMOLOGY Evidence table covering: CATARACT Author Year Study type Population Summary of Paper Comments SIGN 2001 Evidence based Guideline Royal College of Ophthalmolog ists Rose K; Waterman H; Toon L; McLeod D; Tullo A 2001 Evidence based Guideline Scotland UK 1999 RCT N=49 patients UK Elliot DB 1999 General Review & opinion Muthucumara na DJ; Rimmer TJ Gaskell, A.; McLaughlin A.; Young E.; McCristal K.; England 2000 Cohort study N=288 patients (318 eyes) UK 2001 Cohort study Scotland N=169 patients N= 45 optometrist Day Case Cataract Surgery Provides recommendations in planning day case cataract surgery: benefits and risks, pre and post operative assessment and anaesthesia. Also includes information for patients. Cataract Surgery Provides specific details of surgical practice: clinical aspects of cataract surgery (including investigations needed, referral, cataract surgery in diabetic patients); Biometry; day-case or in-patient surgery, Anaesthesia; outcome of cataract surgery, management of posterior capsular opacification, protocol for hospital activity, training for cataract surgery. Also provides information for patients. Aim: to compare the management of patients with cataract referred to a peripheral ophthalmic clinic, where the pre-operative assessment is done by a ophthalmic nurse, with pre-operative assessment done at the main hospital Conclusions: Nurse led pre-operative assessment of patients with cataract at a peripheral ophthalmic clinic is safe, cost-effective and is preferred by patients. This paper gives an overview on the referral and management of cataracts by optometrist. It provides advice on referrals stating that they should be done taking into account the ability of the patient to function in their desired lifestyle and not just their visual acuity. Aim: to determine the outcome of discharge on the first day following cataract surgery and the feedback from patient s optometrists. Conclusions: Patients without complications can be discharged to the care of their optometrist on the first day following cataract surgery. Good communication between hospital and the optometrist is needed. Aim: to determine the feasibility of the direct optometrist referral and combined assessment with same day cataract surgery. Methods: 1-Referral of the optometrist 2-A nurse undertakes a telephone assessment (medical, social and ophthalmic history) 3- Assessment at one day clinic Evidence based recommendations. Grading of the evidence provided. References stated. Developed by a multidisciplinary team. See appendix Cataract 1A, 1B, 1C Evidence based recommendations. Grading of the evidence provided. References stated. Developed by a multidisciplinary team. See appendix Cataract 2A (referral criteria), 2B (investigations and day case surgery), 2C (discharge and post-operative review). References stated. References stated. See appendix cataract 3 for a flow chart on management. References stated. References stated. See appendix Cataract 4A, 4B.
4- Surgery 5- Discharge and follow up Good patient satisfaction. Johnston RL 1994 Opinion USA This paper describes basic concepts as well as practical considerations (examination needed, examination intervals and complications) in the co-management and follow-up of cataract postoperative care by optometrist Latham K; Misson G NHS Modernisation Agency Ayrshire and Arran Board 1997 Questionnaire survey 2000 Expert opinion Guidance document Guidance document Lothian Board Guidance document NHS Modernisation Agency NHS Modernisation Agency NHS Modernisation Agency NHS Modernisation Agency 2000 Expert opinion Guidance document 2000 Expert opinion Guidance document 2000 Expert opinion Guidance document 2000 Expert opinion Guidance document N=75 optometrists; n= 200 GP; n= 41 ophthalmologist (England) UK Scotland Scotland Aim: to compare and contrast the referral criteria adapted by optometrists, GPs and ophthalmologists to see if they are consistent. Results: important criteria for cataract referral: visual acuity, the patient s visual difficulties due to the cataract and their need to drive. Also all professions felt that improving communication across professions would help the referral system. Guidance for the Redesign of the services on Cataracts. Provides information about the patient journey, referrals (professionals involved), information about waiting times, overall information on cataract surgery and demographics and information for planning the services. Also provides information for patients. Cataract Referral Process document Pathway for the referral from the Optometrist to one stop clinic for surgery. Cataract services Information given: referral criteria for Cataract surgery, referral document and information for patients. See appendices cataract 5A, 5B, 5C References stated. Developed by group of experts. Based on best practice. References provided. See appendix Cataract 6A (patient journey), 6B (referrals), 6C (one stop clinic). 6D (Pre-operative assessment), 6E (post operative assessment), 6F (information for patients) Methodology not stated. See appendix Cataract 7 Methodology not stated. See appendix Cataract 8 UK Proposed Cataract Pathway I Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 9 UK Proposed Cataract Pathway II Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 10 UK New Cataract Service Patient Pathway Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 11 UK Direct booking to waiting list for Cataracts patients Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 12
NHS Modernisation Agency York NHS trust Tauton and Somerset NHS trust Salisbury District Hospital Milton Keynes Warwick Hospital NHS Modernisation Agency Winchester NHS Trust West Suffolk NHS trust Royal College of Ophthalmolog ists 2000 Expert opinion Guidance document 2000 Expert opinion Guidance document 2000 Expert opinion Guidance document 2000 Expert opinion Guidance document 2000 Expert opinion Guidance document 2000 Expert opinion Guidance document 2000 Expert opinion Guidance document 2000 Guidance document 2000 Guidance document 2004 Guidance document UK Standard referral form for use by optometrist on cataracts referrals Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 13 UK Optometrist referral to cataract clinic Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 14 UK Patient Care Pathway Cataract Surgery Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 15 UK Patient Care Pathway Cataract Surgery Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 16 UK Patient Care Pathway Cataract Surgery Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 17 UK Cataract Pathway Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 18 UK Patient Pathway Cataract Surgery Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 19 UK Direct Cataract Referral Patient Care Pathway Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 20 UK Cataract Patient Care Pathway Part of NHS Modernisation Agency Action On project. Developed by group of experts See appendix Cataract 21 UK The purpose of this document is to provide guidance on the standards References stated. which comminissioning agencies should expect of any provider of ophthalmic care, whether in the NHS, in independent sector treatment centres or abroad, with whom thy plan to place contracts for cataract surgery.
Appendix 1A
Appendix 1B
Appendix 1C
Appendix 2A
Appendix 2B
Appendix 2C
Appendix 3
Appendix 4A
Appendix 4B
Appendix 5A
Appendix 5B
Appendix 5C
Appendix 6A
Appendix 6B
Appendix 6C
Appendix 6D
Appendix 6E
Appendix 6F
Appendix 7
Appendix 8
Appendix 9
Appendix 10
Appendix 11
Appendix 12
Appendix 13
Appendix 14
Appendix 15
Appendix 16
Appendix 17
Appendix 18
Appendix 19
Appendix 20
Appendix 21