Delays in follow-up appointments increase the risk of sight loss

A new report into the capacity of hospitals for treating glaucoma patients has been published

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Delays to follow-up appointments for patients living with glaucoma is increasing the risk of sight loss, the Healthcare Safety Investigation Branch (HSIB) has warned in a new report.

The report identifies that there is inadequate capacity at hospital eye services to meet the demand for glaucoma services.

The authors highlight that “smarter ways of working” should be introduced to maximise the current capacity, sharing that measures have been implemented in some trusts but have not been widely adopted.

HSIB notes that the vast majority of suspected glaucoma referrals are made by optometrists and many patients are subsequently found not to have glaucoma. It highlighted glaucoma filtering schemes that have been commissioned locally to reduce the number of referrals.

Other findings in the report include increasing capacity through redesigned pathways that enable trained members of a multidisciplinary team to take on tasks previously performed by ophthalmologists and virtual clinics to assess new referrals and to follow-up with patients.

Chief investigator at HSIB, Keith Conradi, said: “Our investigation offered an independent view on why current systems and processes have not adequately addressed the problem. It identified learning that can positively influence practice across the NHS.

“By highlighting the pertinent issues, our safety recommendations direct organisations to make changes to help reduce the burden on hospital eye services, and lessen the personal loss and distress suffered by patients and their families.”

In the report, HSIB recommends that the Royal College of Ophthalmologists works with relevant stakeholders to develop models and review the workforce required for the delivery of glaucoma care.

President of the Royal College of Ophthalmologists, Mike Burdon, said: “We have been campaigning for some time on how the delays to follow appointments results in the loss of vision for patients. The HSIB report and the recommendations are extremely welcomed and must not be overlooked. With demand for ophthalmic services predicted to rise by more than 40% over the next 20 years, urgent action is needed, and we look forward to working with NHS England and other key stakeholders to the transformation of ophthalmic services to safeguard the sight of patients.”

Speaking about the report, the AOP’s clinical director, Dr Peter Hampson, highlighted that the issue has been known about for some time.

“The Royal College of Ophthalmologists highlighted in 2017 that as many as 22 patients a month might be losing vision as a result of delayed follow-up appointments. Many of these patients will have been glaucoma patients,” he said.

“We agree with HSIB’s recommendations that fuller use of the skills of other professionals such as optometrists could release the time of ophthalmologists to be used for work that only they can do. Repeat measures and referral refinement schemes can reduce the number of patients attending hospital eye service clinics and community follow-up of low-risk glaucoma patients can mean quality care closer to home,” Dr Hampson added.

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