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Cataract Surgery Redesign: Meeting Increasing Demand, Training, Audit and Patient-Centered Care

Authors Ah-See KL, Blaikie A, Boyle N, Foulds J, Wheeldon C, Wilson P, Styles C, Sutherland S, Sanders R

Received 17 June 2020

Accepted for publication 21 September 2020

Published 25 January 2021 Volume 2021:15 Pages 289—297


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Kim Lawrence Ah-See,1 Andrew Blaikie,2 Natalie Boyle,3 Jonathan Foulds,3 Catherine Wheeldon,3 Peter Wilson,3 Caroline Styles,3 Shona Sutherland,3 Roshini Sanders3

1Department of Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, Scotland, UK; 2School of Medicine, University of St Andrews, St Andrews, Scotland, UK; 3Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK

Correspondence: Kim Lawrence Ah-See
Princess Alexandra Eye Pavilion, Edinburgh, Scotland, United Kingdom

Objective: The demand for cataract surgery in Fife (a well-defined region in southeast Scotland) was steadily increasing over 15 years. Cataract surgery was therefore being outsourced to meet demand with consequences on list mix, training needs, patient experience and staff morale. We aimed to redesign our services to meet local demand, retain a patient-centered service and continue to fulfil training needs.
Methods: We quantified cataract surgery delivery over an 18-month period: before, during and after redesign of services. We studied numbers of operations, trainee cases and number of outsourced cases. We also considered the economic implications of the redesign.
Results: We studied three periods (each of six months duration): before redesign (BR), redesign period (RP) and post-redesign (PR). Data were collected on total operation numbers, number of cases performed by trainees, and numbers performed out with normal working hours (weekend lists) and external providers. An economic analysis examined the cost of outsourcing cataracts during BR and RP and the costs of the redesign, including building, equipment and additional nursing staff.
Conclusion: Regional fulfilment of cataract surgery provision remains a continuous challenge within the NHS. We show that with minimal investment, smart redesign process and collaborative working, increased local provision is possible while fulfilling trainee needs and achieving the necessary clinical audits and national standards.

Keywords: cataract surgery, healthcare policy, training, service provision

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