The effect of appointment rescheduling on monitoring interval and patient attendance in the glaucoma outpatient clinic

Tatham, Andrew J.; Murdoch, Ian

doi:10.1038/eye.2012.22

Cited by 24 publications

(21 citation statements)

References 8 publications

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“…The majority of patients had chronic conditions requiring continuous long-term follow-up, similar to that reported at Moorfields Eye Hospital 3 and this is likely to indicate an association between patient need and lack of health service capacity. The commonest reported diagnosis was glaucoma, a condition for which delayed follow-up has previously been reported as a preventable cause of loss of vision 4 (http://www.telegraph.co.uk/news/uknews/ 1437054/Optitians-blame-patients-loss-of-sight-ontargets.html). Within the context of an aging population, in which the estimated prevalence of glaucoma increases from 0.3% in the 40-50-year olds to 3.3% in those over 70, 5 Main Causes of Delay Figure 2 The majority of patients who came to harm had a follow-up appointment that was delayed.…”

Section: Discussionmentioning

confidence: 99%

Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome

Foot

MacEwen

2017

Eye

125

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Purpose To determine the frequency of patients suffering harm due to delay in ophthalmic care in the UK over a 12-month period. Methods Patients with deterioration in vision in at least one eye of 3 lines of Snellen acuity or 15 letters on ETDRS chart or deterioration in visual field deviation of 3 decibels due to health service initiated delay in review or care were ascertained through the BOSU using prospective active surveillance involving all UK consultant ophthalmologists. Demographic details, diagnosis, cause and length of delay, and vision loss were then sought by questionnaire. Results 238 cases reported between March 2015 and February 2016. 197/238 questionnaires were returned (83%). Twentyeight reports were out of the study period or did not meet the case definition. Median age was 76 years (range: 1 to 98 years). Median delay was 22 weeks (range: 2 days to 5½ years). Seventy two per cent experienced permanent reduction in visual acuity, 23% permanent deterioration in visual field. Main diagnoses were Glaucoma 42%, Age-related Macular Degeneration (AMD) 23%, and Diabetic Retinopathy (DR) 16%. Eighteen patients were eligible for Severely Sight Impaired (SSI) or Sight Impaired (SI) registration. Main causes were delayed follow-up (76%), lost referral (7%), and delayed treatment (8%). Conclusion Patients are suffering preventable harm due to health service initiated delay leading to permanently reduced vision. This is occurring in patients of all ages, but most consistently in those with chronic conditions. Delayed follow-up or review is the cause in the majority of cases indicating a lack of capacity within the hospital eye service.

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Section: Discussionmentioning

confidence: 99%

Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome

Foot

MacEwen

2017

Eye

125

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“…In particular, patients worried that appointment cancellations could extend the interval between tests beyond what was recommended by the clinician, therefore leaving them exposed to undetected disease progression. It is known that while clinicians select appropriate monitoring intervals, hospital-initiated rescheduling is a major challenge to appropriate follow-up 7 34 35. Moreover, it was typical for patients to wait at the clinic for hours in order to complete multiple vision tests, causing frustration and tiredness which some perceived to influence their subsequent performance.…”

Section: Discussionmentioning

confidence: 99%

A qualitative investigation into patients’ views on visual field testing for glaucoma monitoring

2014

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ObjectivesTo investigate the views and experiences of patients regarding their glaucoma follow-up, particularly towards the type and frequency of visual field (VF) testing.DesignA qualitative investigation using focus groups. The group discussion used broad open questions around the topics in a prompt guide relating to experiences of glaucoma follow-up, and in particular, VF monitoring. All the groups were taped, transcribed and coded using manual and computer-aided methods.SettingThree National Health Service (NHS) hospitals in England; two focus groups took place at each hospital.Participants28 patients (mean (SD) age: 74 (9) years; 54% women) diagnosed with glaucoma for at least 2 years. Each focus group consisted of 3–6 patients.Primary and secondary outcomes(1) Attitudes and experiences of patients with glaucoma regarding VF testing. (2) Patients’ opinions about successful follow-up in glaucoma.ResultsThese patients did not enjoy the VF test but they recognised the importance of regular monitoring for preserving their vision. These patients would agree to more frequent VF testing on their clinician's recommendation. A number of themes recurred throughout the focus groups representing perceived barriers to follow-up care. The testing environment, waiting times, efficiency of appointment booking and travel to the clinic were all perceived to influence the general clinical experience and the quality of assessment data. Patients were also concerned about aspects of patient–doctor communication, and often received little to no feedback about their results.ConclusionsPatients trust the clinician to make the best decisions for their glaucoma follow-up. However, patients highlighted a number of issues that could compromise the effectiveness of VF testing. Addressing patient-perceived barriers could be an important step for devising optimal strategies for follow-up care.

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“…9 In our project, we identified 16 patients who had come to serious harm as a result of LTFU. Although this is a small number in the overall context of the project, for all of these patients it had a profound effect on their vision, which could have been prevented.…”

Section: Discussionmentioning

confidence: 99%

A review of 145 234 ophthalmic patient episodes lost to follow-up

Davis

Baldwin

Hingorani

et al. 2016

Eye

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Purpose Lost to follow-up and delays in follow-up care are a major problem in chronic diseases, particularly when irreversible progression precedes symptoms. The NPSA Glaucoma Safety Alert in 2009 highlighted the risk and requirements for consistent robust review systems in ophthalmology. In response, Moorfields Eye Hospital reviewed the records of all patients in all subspecialties without review appointments booked. The purpose of this study was to determine whether ophthalmic patients lost to follow-up had come to harm and develop investigation techniques to optimise safety, which do not put excessive demands on clinical staff time. Methods The health records of all patients lost to follow-up (LTFU) between July 2007 and November 2012 were reviewed for evidence of clinical harm using a risk-based strategy involving an initial administrative review, then a clinician led electronic patient record review, followed by a review of paper records by clinicians. The final stage was a clinical outpatient review where required determined by clinical risk. Results Patients identified as lost to follow-up were 145 234; 79 562 episodes were closed following administrative review; 50 519 were discharged following clinician examination of paper records; 12 316 patients required clinical review; and 16 serious incidents were identified, of which 14 patients had glaucoma, 1 a medical retinal condition with secondary glaucoma, and 1 an oculoplastic condition. A number of actions implemented hospital wide are described which minimise future risk. Conclusion Risk from delays or lost to follow-up care continue and require better capacity and more accurate data nationally.

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The effect of appointment rescheduling on monitoring interval and patient attendance in the glaucoma outpatient clinic

Abstract: Aim To assess the effect of appointment rescheduling on monitoring intervals and patient attendance in the glaucoma clinic.

Cited by 24 publications

References 8 publications

Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome

Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome

A qualitative investigation into patients’ views on visual field testing for glaucoma monitoring

A review of 145 234 ophthalmic patient episodes lost to follow-up

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