Transformational change: nurses substituting for ophthalmologists for intravitreal injections &amp;ndash; a quality-improvement report

Michelotti, Monica; Abugreen, Salwa; Kelly, Simon P.; Morarji, Jiten; Myerscough, Debra; T, Boddie; Haughton, Ann; Nixon, Natalie; Mason, Brenda; Sioras, Evangelos

doi:10.2147/opth.s59982

Cited by 20 publications

(28 citation statements)

References 24 publications

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“…For instance, re-allocating administration of intra-vitreal injections from physicians to nurses was shown to be a resource-efficient usage of personnel that enabled hospitals to cope with an increase in physicians’ workload. DaCosta and colleagues [ 46 ] together with Michelotti and colleagues [ 47 ] suggested that skill mix (changing professional roles) [ 48 ] is beneficial, acceptable to patients, and an effective use of resources. The effectiveness of skill mix across professions remains relatively unexplored [ 49 ] and the likely consequences of skill mix change need to be explored [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

A study of unreasonable illegitimate tasks, administrative tasks, and sickness presenteeism amongst Norwegian physicians: an everyday struggle?

Thun

Halsteinli

Løvseth

2018

BMC Health Serv Res

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BackgroundIt has been shown that a recently defined stressor, ‘illegitimate tasks’, has negative effects on employees’ work motivation and health. Better understanding of the illegitimate tasks undertaken by physicians might contribute to a more resource-efficient division of labour within the health care system, with beneficial effects on organisational economics and employee performance. We aimed to investigate the prevalence of unreasonable illegitimate tasks, their associations with workplace variables and their impact on health, in particular sickness presenteeism.MethodsCross-sectional data were collected in 2012. A sample of 545 Norwegian physicians answered an online questionnaire. The response rate was high (71.8%). The data were analysed using independent-samples t-tests, ANOVA and logistic regression.ResultsAbout 50.2% of physicians in all clinical positions reported that at least 11% of their everyday tasks could have been done by other hospital personnel. Seven percent of the physicians reported that at least 31% of their daily workload consisted of unreasonable illegitimate tasks. There were no significant differences in unreasonable illegitimate tasks according to clinical position, age or gender. Administrative task load and role conflict were positively associated with unreasonable illegitimate tasks that physicians reported could be reallocated to non-medical professionals. Moreover, unreasonable illegitimate task was associated with a higher probability of sickness presenteeism after controlling for age, gender, role conflict, control over work pace, exhaustion and administrative tasks.ConclusionsThe results confirm that physicians’ workload includes a high proportion of unreasonable illegitimate tasks and that this can contribute to sickness presenteeism. Investigation of work environmental factors can provide insight into the mechanisms behind unreasonable illegitimate tasks. Decreasing the amount of administrative tasks and role conflicts faced by physicians should be a priority. These findings could be used to make hospital task management more resource-efficient. Our results indicate that a substantial proportion of physicians’ work capacity could be re-allocated to core tasks. Further research is needed into the specific type and content of unreasonable illegitimate tasks undertaken by physicians in order to determine to whom they should be allocated to ensure a healthy and motivated workforce and provision of high quality, resource-efficient health care services.

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Section: Discussionmentioning

confidence: 99%

A study of unreasonable illegitimate tasks, administrative tasks, and sickness presenteeism amongst Norwegian physicians: an everyday struggle?

Thun

Halsteinli

Løvseth

2018

BMC Health Serv Res

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“…To extrapolate, the favorable safety profile of this device even when used by novices implies its potential to be deployed as an assistive device to facilitate the administration of intravitreal injections by trained vitreoretinal nurses, further reducing the injection burden on doctors. 19 …”

Section: Discussionmentioning

confidence: 99%

Intravitreal Injection with a Conjunctival Injection Device: A Single-Center Experience

Soh

Chiam

Tsai

et al. 2020

Trans. Vis. Sci. Tech.

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To evaluate the clinical performance of the intravitreal injection assistant device (InVitria) compared with the conventional freehand technique for delivering intravitreal injections. Methods: Seventy patients were randomized to receive intravitreal injections via the conventional freehand technique while 70 received injections using the InVitria. Half of all procedures in each group were performed by junior surgeons, while the rest were performed by senior surgeons. Results: Mean injections times were 90.0 ± 23.3 seconds and 64.9 ± 26.8 seconds for conventional versus InVitria (P < 0.001). Mean injection times with the conventional technique were 85.5 ± 23.0 seconds vs. 94.2 ± 23.0 seconds for senior versus junior surgeons (P = 0.120). Mean injection times with the InVitria were 56.1 ± 26.1 seconds vs. 66.3 ± 26.9 seconds (P = 0.211) for senior versus junior surgeons. There were no significant differences in pain scores regardless of technique (conventional versus In Vitria: 2.03 ± 1.73 vs. 2.13 ± 2.20, P = 0.770). Conclusions: In our experience, the InVitria is a comparable alternative to the conventional freehand technique of delivering intravitreal injections, with the potential for faster injection times and without compromising on patient comfort. Translational Relevance: The study provides evidence to suggest that the InVitria may be deployed effectively in clinical practice.

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“…Nurse injectors have been demonstrated to be able to provide a safe and effective injection service that is well received by patients. 9,19 Costs to the NHS and drug label status were of the least importance to patients and this has potential important consequences to the way off-label drugs are used. There is much in the recent literature debating the use of off-label anti-VEGF agents due to their significant cost saving.…”

Section: Discussionmentioning

confidence: 99%

Determining patient preferences in the management of neovascular age-related macular degeneration: a conjoint analysis

Baxter

Fotheringham

Foss

2016

Eye

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Purpose To determine the opinions from a patient perspective on relevant variables in the delivery of treatment for neovascular age-related macular degeneration (nAMD). Methods Pilot interviews with patients and doctors were conducted to identify what variables in the provision of a nAMD service were important. This led to the generation of two sets of scenario options. Subsequently 100 patients undergoing active treatment for nAMD in the National Health Service University Hospital, United Kingdom underwent interview assessment. They were asked to rank their preferences for provision of their care with reference to these two sets of scenario options. Using conjoint analysis, percentage preferences, and utility scores for each variable in each scenario design were calculated. Results Ninety-five patients completed the preference ranking for both scenarios. Eight patients ranked worse vision as preferable to better vision and were excluded on the basis that they had not understood the task. The results of the remaining 87 patients are presented. The most important factor to patients was having good vision, followed by a one-stop service and less frequent follow up. The least important factors were label status of the drug, cost to the health service, and grade of the injector. Conclusion Patients regard good vision and minimal visits to the hospital above the status of injector, label status of drug, or cost to the NHS.

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Transformational change: nurses substituting for ophthalmologists for intravitreal injections – a quality-improvement report

Cited by 20 publications

References 24 publications

A study of unreasonable illegitimate tasks, administrative tasks, and sickness presenteeism amongst Norwegian physicians: an everyday struggle?

A study of unreasonable illegitimate tasks, administrative tasks, and sickness presenteeism amongst Norwegian physicians: an everyday struggle?

Intravitreal Injection with a Conjunctival Injection Device: A Single-Center Experience

Determining patient preferences in the management of neovascular age-related macular degeneration: a conjoint analysis

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