Review of Southern DHB ophthalmology service supports changes

An external review of ophthalmology services at Southern DHB has “lent confidence to the initiatives that are underway, and provided additional areas for consideration”, says Chief Medical Officer Dr Nigel Millar.

The review was undertaken by Counties Manukau ophthalmologist Dr James Stewart, and Wellington-based health care consultant Kate MacIntyre, to assist the DHB in understanding the 34 adverse events it had reported, resulting from the long waiting times being experienced by patients in this service.

It was commissioned as part of a broader service improvement programme, which commenced in 2015. This has seen the number of patients overdue for a follow up appointment reduce from 4618 in October 2016 to 3432.

Dr Millar thanks the reviewers for their careful investigation, and the staff at the DHB for openly sharing their experiences in the interests of learning from these outcomes and ensuring we provide the best possible service to our patients.

“We appreciate the recommendations, and it was encouraging that many of these are already in progress. This gives us greater confidence we are moving in the right direction in delivering this service, through growing our capacity and adapting our models of care to cope with the volume of patients.”

He said the DHB also valued the reviewers’ further suggestions, including further possible enhancements to patient flow, additional prioritisation processes, making greater use of the wider health care workforce and reconsidering the physical layout of the clinics. “We will be considering all of the issues raised and points made in the report to ensure we do everything we can to improve this service.”

The reviewers recommended new criteria for calculating when a patient is “overdue”. By this definition, the number of patients whose appointments are overdue is now provisionally estimated to be around 2000.

The reviewers also determined that 23 of the 34 reported cases met the criteria of serious adverse events. However, they commended Southern DHB for the culture of reporting, leading to the wider range of cases being considered.

Dr Millar reiterated his concern for the patients whose experiences were at the centre of this review.

“We apologise for our failure to deliver the care they were entitled to. I especially want to assure all patients that while not all of the cases were determined by the reviewers to meet the criteria of a serious adverse event, this in no way minimises the seriousness with which we are taking these cases or the loss of vision those patients have experienced in our care.”

Key recommendations from review

  • Capacity needs to be addressed, and demand carefully monitored
  • Dedicated service management or coordination is required for each site
  • Prioritisation of patients to be enhanced
  • Southland patients should have direct phone access to the service, as per Dunedin
  • Better systems for management of referrals and follow ups required
  • Ongoing review of efficiencies
  • Additional service credentialing
  • Improvements needed nationally
  • Sharing learning from this report is recommended.

Southern DHB ophthalmology: key facts

  • Since implementing a service recovery programme in 2015, the number of patients overdue for a follow up appointment have reduced from 4718 (Oct 2015) to 3432 (May 2017). This is a reduction from 31% of patients overdue to 26%.
  • New criteria have been recommended by the reviewers for calculating the number of overdue patients. This further reduces those patients defined as overdue to approximately 2000. This represents 10% of patients now classed as overdue for a follow-up appointment.
  • Continuing service improvements include:

Increasing capacity

  • engaging locum specialists, and employing an additional ophthalmologist
  • employing in-house optometrist

  • training registered nurses to become Avastin injectors

Changes to models of care

  • Patients referred to GPs for repeat scripts

  • Health care assistants performing visual acuity assessments

  • Optometrists and nurses providing assessments and treatments  where clinically appropriate

Improving systems

  • Utilising acuity tool and clinically assessed “do not delay” patient groups to better identify high-risk patients

  • Review of patient flow

 

  • Southern DHB anticipates reducing waiting lists to zero overdue patients by September 2017.

The full report is available to read here. Please note, the redaction on page 14 has been made to protect the privacy of individual patients who may be identified from the content of the redacted paragraphs.