Abstract
Background
Moorfields Eye Unit at the London Borough of Croydon sees over 47,000 outpatient attendances each year, 5894 of which attended the eye walk-in Urgent Care in the 2017– 2018 year, which has become unsustainable.
Methods
A recent audit found that referrers and patients had limited experience in managing ophthalmic conditions. If triaged according to clinical need only 22% patients attended required same-day hospital eye care. As such the service needed to be reconfigured. This was achieved through extensive collaboration with our local Clinical commissioning groups (CCG), General Practitioner (GP) body, Optometrists and host hospital at the Croydon University Hospital. The Rapid Access Clinic (RAC) was set up in November 2018 to replace the old-style walk-in pathway and provide a streamlined emergency eye care service for patients.
Results
RAC demonstrated an efficient and safe triage system which can improve patient flow. Since the launch date of RAC on the 1st November 2018, a 50% sustained decrease in attendances to urgent care was noted. This was achieved without impacting other eye services, by advising the referrers and redirecting referrals appropriately. At the same time the appropriateness of the attendances to our emergency clinic improved from 32% to 68%. Using a digital platform for referrals and data collection allowed up to continuously perform service evaluation.
Conclusion
The forward-online triage and our close relationship with community enabled a safe continuation of providing emergency eye care locally. The controlled booked attendance as well as the advice and guidance system enabled us to prioritise true emergencies.
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Data availability
The data that support the findings of this study are not publicly available due to reasons of sensitivity, but are available from the corresponding author upon reasonable request with permission from Moorfields Eye Hospital. Data are located in controlled access data storage at Moorfields Eye Hospital NHS Foundation Trust.
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Acknowledgements
We thank Ms Rose Sebwato, Rapid access clinic nurse for Moorfields eye centre at Croydon University Hospital, Moorfields Eye Hospital NHS Foundation Trust for her contribution in the redesign of the rapid access clinic and discussion of ideas for this paper. We also thank Yi-Hwa Lin for her design of Fig. 1.
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P-FL devised the project, the main conceptual ideas and proof outline. ME did the writing of the manuscript with support from ATH, EO, and P-FL. P-FL, ME, and ATH the design and contents of the tables and figures. All authors discussed the content and commented on the manuscript.
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Eleftheriadou, M., Han, A.T., O’Sullivan, E. et al. The rapid access eye clinic’s playbook: how to cut eye casualty attendance by 50%. Eye 38, 259–265 (2024). https://doi.org/10.1038/s41433-023-02669-8
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DOI: https://doi.org/10.1038/s41433-023-02669-8