Project Name: Development of a tele-ophthalmology service consisting of case triaging via central OCT reading and referral refinement between community and secondary care, to reduce unnecessary referrals into wAMD services.
Project Summary: Specifically, via digitally connecting community optometrists to allow the secure transfer of clinical patient information and OCT readings to Moorfields South sites, the Joint Working Project aims to:
- provide triaging and screening resource to review referrals and provide recommendations;
- reduce the number of unnecessary patient referrals from optometrists to the Moorfields wAMD clinics;
- improve patient outcomes and experience by reducing time between referral, diagnosis, and treatment, and increasing awareness of the wAMD pathway and empowerment of their care.
- provide feedback to optometrists on referral accuracy and improve referral data capture for the catchment areas;
- write-up the methodology and create a case study for other Trusts to understand and replicate the process in their service.
Expected Patient Benefits for this Project:
- Improved patient outcomes due to faster time to diagnosis and treatment.
- Enhanced patient experience of the NHS wAMD service by avoiding unnecessary visits to Moorfields South sites, especially during Covid-19.
- Improved care received by the community optometrists due to passive upskilling and training via the use of the digital tele-ophthalmology service.
Start Date & Duration: November 2020 - March 2022, 16 months
November 2020 | OPT20-C025a
Project Name: Development of a tele-ophthalmology service consisting of case triaging via central OCT reading and referral refinement between community and secondary care, to reduce unnecessary referrals into wAMD services
Completion Date: July 2022
The project’s objective was to create a centralised triaging hub to streamline incoming referrals with the aim to reduce unnecessary referrals entering secondary care and reduce referral to treatment time. This was achieved by setting up a digital triaging hub with the ability to receive data from community optometrists, clinically review the data, provide feedback to the optometrists, and process the referrals based on the clinical pathway.
Key Project Outcomes Data:
- Unnecessary referrals were reduced by 13% freeing up capacity within the service
- Average turnaround time for triaging activity was 1.5 days
- 31% of referrals were downgraded from urgent to routine freeing up critical urgent appointments for patients
The project was able to provide multiple benefits to patients and the NHS. In particular patients:
- Received an enhanced patient experience of the Moorfields Macular Service by avoiding unnecessary visits to Moorfields South sites, especially during Covid-19
- Had improved care received by the community optometrists due to passive upskilling and training.
- Patients requiring care, received a faster referral to treatment time
The project enabled the NHS to:
- Test a new model of care and approach to receiving referrals into a centralised digital triaging hub
- Collect data and monitor the impact and outcomes of a new model of care
- Benefit from a more efficient system that freed up capacity within Moorfields South site
The project also highlighted improved learnings for the community optometrists that took part in the pilot. At the start of the project the downgrade rate was 46% and the rejection rate was 17%. This improved over the course of 15 months, where by the end of the project the downgrade rate was 31% and rejection rate was 13%. These improvements highlight the importances of the feedback mechanism set up by the triaging hub to help the community optometrists upskill and learn from their referrals.
Quote from Partner:
“I am particularly proud for the success of this highly pioneering joint works project between Moorfields Eye Hospital and Novartis. The objective was to establish a centralised telemedicine service at the Moorfields Ophthalmic Reading Centre to support a digital, centralised and quality assured tele-Ophthalmology triaging pathway for community optometry referrals addressed to the Moorfields Eye Unit at St George’s Hospital.
This project commenced in 2020 and was successfully completed with very encouraging results.
The concept of centralised, teleophthalmology referral triaging, introduced for the first time through this innovative collaboration, became the inspiration for broader, regional initiatives for Centralised Telemedicine Services in Eye Care currently being piloted with the support of NHSE. The results of such pilot initiatives will inform potential plans for national expansion of Centralised Telemedicine Eye Services.
A centralised digital triaging system for referrals between community optometry and hospital-based eye services using teleophthalmology technologies can provide multiple benefits, including:
Improved patient care:
- The system can provide real-time access to patient data and images, allowing hospital-based experts to make the most appropriate referral recommendation for each patient. Digital triaging can streamline the referral process and reduce wait times for patients.
- Centralised Teleophthalmology Referral Triaging can enable optimising service planning based on more accurate estimates of expected activity and capacity pressures.
- The system can facilitate communication and collaboration between community optometry practices and hospital-based eye services, leading to better coordination of patient care. Through bi-directional communication, the system can support Advice & Guidance and contribute to upskilling our community optometry workforce.
- Reducing the need for face-to-face visits and travel, teleophthalmology technologies can help reduce healthcare costs and improve patients’ experience of care.
- Teleophthalmology can bring specialist care to patients in remote and underserved areas, but, more importantly in an urban context, it can ease capacity pressures on eye services, aggravated by high numbers of unnecessary hospital visits, thus reducing waiting times and increasing prompt access to quality eye care and vision-saving treatments for the patients that would most benefit from them.
Overall, a centralised digital triaging system using teleophthalmology technologies can improve patient outcomes, increase efficiency and accessibility of eye care, reduce healthcare costs and inequalities, and provide an improved experience of care for our patients. “
Professor Konstantinos Balaskas,
Moorefield Eye Hospital NHS Foundation Trust.
This work highlights the importance of data sharing and a centralised triaging hub between community optometrists and secondary care.
As a result, the project has given rise to a number of potential new models of care, maximising the use of our healthcare resources, providing greater integration, and increasing the skills and confidence of our community optometrists when referring patients.