A new clinic led by upskilled orthoptists is helping a leading Melbourne hospital reduce cataract wait times and streamline follow up appointments. JULIE TAYLOR reflects on its successes and future plans.
The Royal Victorian Eye and Ear Hospital has been proactive in seeking and supporting non- medical models of care in the ambulatory services setting to offset the workload from the traditional medical model. These alternate models of care have been employed where there are recognised service gaps including high demand and/or medical workforce shortages.
A success story for the hospital has been the development of an orthoptic led post-operative cataract clinic (OSOP) in response to a program funded by Better Care Victoria to identify and embed innovation across our health service.
The primary objectives for developing the OSOP clinic model was specifically to reduce appointment wait times and streamline follow up appointments for our post-operative cataract patients.
For the 664 patients who have been through the clinic since late 2017 we have achieved:
- 93% patient satisfaction rate with OSOP clinic.
- 84% of respondents felt the time spent in clinic was ‘about right’ with the average time spent in OSOP ranging from 45-86 minutes.
- 86% of respondents happy to be reviewed by an orthoptist instead of a doctor.
The format of the OSOP clinic is specifically for the assessment of routine, three-week post-operative cataract patients by credentialed orthoptists, with the aim to discharge patients to a community provider where there are no clinical concerns.
To determine suitability for discharge, assessment of these patients is undertaken against a clinic-specific pro forma designed by the medical staff which is inclusive of ocular history, visual acuity, best corrected visual acuity, retinal examination (via Optos imaging) and a complete slit lamp examination.
Any patient who is noted at this three-week visit to have reduced vision, refractive surprise, post-operative inflammation, retinal changes or any other concerns, are immediately transferred to the doctor-led cataract clinic that runs concurrently with OSOP.
The benefit of this clinical rostering format is that the patient is never at a disadvantage to their care should they require medical intervention.
In addition, this direct relationship with the ophthalmologists also provides the opportunity for the ongoing exchange of clinical information and development of clinical skills for our OSOP orthoptists.
Even with the fantastic results we have achieved and the positive response from staff involved, what is now most exciting about this clinical innovation is that it has continued to evolve and expand.
What started as a very successful non-medical post-operative cataract clinic model running fortnightly, has now evolved into the review of patients for both post-operative cataract care and post-operative pterygium care and runs three sessions per week.
With expansion comes the need to have more orthoptists credentialed to undertake assessments.
Since the program’s inception, we had three specially trained and credentialed orthoptists, with a further three credentialed over the past 12 months due to clinical demand, and another three currently in training.
The process for training and credentialing is four-pronged, inclusive of group training sessions, one-on-one training sessions with ophthalmologists, knowledge of theory and principles, with a key addition to our training program being the ability to provide a mentoring program where credentialed orthoptists mentor the orthoptists-in-training.
Oversight of the program continues to be provided by the Surgical Ophthalmology workforce – headed by Dr Anton Van Heerden, Head of Surgical Ophthalmology Services at The Eye and Ear. He says the introduction of our orthoptic-led clinics has allowed the hospital to improve clinical efficiencies, reduce wait times and maintain clinical excellence.
He believes also this initiative also paves the way for future similar projects utilising the skills and knowledge of our allied ophthalmic healthcare providers to improve services.
As an OSOP credentialed senior orthoptist at The Eye and Ear, I believe this program has been a win-win for all involved. The patients are appreciative of the exceptional service they receive, referring practitioners are being kept in the loop as to their patient’s ocular status, and the orthoptists who are working on the clinic are loving the challenge and the chance to provide a service of the highest standard.
The future is looking bright for the clinic. Where do we see ourselves in 12 months? We are looking to have our entire Eye and Ear orthoptic workforce trained to undertake this level of assessment so that is where I am hoping we can get to. n
ABOUT THE AUTHOR: Julie Taylor is a grade 3, senior orthoptist and oculo-plastics clinic liaison. She has worked at the Royal Victorian Eye and Ear Hospital for over 20 years and specialises in competency and credentialing packages.