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Bristol Eye Hospital CaB Services

Bristol Eye Hospital CaB Services. Referral Management at BEH. Referral received (around 900 pm) Pulled from CaB (target 48 hours) Triaged by consultant (target one week) Referral returned to booking team who update CaB (accept/reject/rebook) and confirm to patient. Why does it take so long?.

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Bristol Eye Hospital CaB Services

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  1. Bristol Eye Hospital CaB Services

  2. Referral Management at BEH • Referral received (around 900 pm) • Pulled from CaB (target 48 hours) • Triaged by consultant (target one week) • Referral returned to booking team who update CaB (accept/reject/rebook) and confirm to patient

  3. Why does it take so long? • Volume • 900+ referrals received via CaB per month • An additional 500 patients are re-booked or cancelled • Insufficient capacity means that some patients have to book appointments outside of 13 weeks waiting time target (these patients then have to be re-booked) • Plus some patients book appointments in the wrong clinic (again these patients have to be re-booked) • Process • Delay in pulling referrals off CaB lead to delays in Consultant triage • Process results in peaks and troughs, not a steady workflow

  4. What are we doing about it? • Changes to our process • Increased staff to manage workload • Increased Consultant engagement and support • Average triage time reduced from 30 to 20 days • Target = 7 days

  5. Services Medical Retina Service Vitreo-Retinal Service Uveitis Service Corneal Service Glaucoma Service Cataract Service YAG Capsulotomy Laser Service Oculoplastic Service (Adults & Children) Paediatric Ophthalmology Squint/Strabismus/Ocular Motility (Children) Squint/Strabismus/Ocular Motility (Adults) Adnexal Service General Ophthalmology Service

  6. Medical Retinal Service Macular degeneration (Age Related Macular Degeneration - AMD) History of visual loss/ visual distortion Diabetic related eye problems Eye problems as a result of hypertension Central retinal vein/ artery occlusions Degenerative retinal conditions- Retinitis pigmentosa Pigmented fundal lesions/ choroidal masses Vitreo-Retinal Flashes/ floaters Retinal detachments, retinal tears Lattice degeneration Vitreous haemorrhage/ opacity Proliferative diabetic retinopathy Macular oedema Not AMD

  7. Uveitis Ocular inflammatory disease Uveitis/ iritis/ choroiditis Painful red eye Anterior/posterior scleritis Inflammation associated with systemic disease i.e. rheumatoid eye problems

  8. Glaucoma Raised intra ocular pressure Optic disc cupping Visual field defects Ocular hypertension Cornea Corneal disease including infection Corneal dystrophies Keratoconus Pterygium Marginal lid disease Dry eyes

  9. Cataract Refer when symptoms disrupting daily activities, or work, whatever the level of vision. Car drivers need at least 6/9 in better eye. Lens opacity General blurred or dim vision. Glare in sunlight. Monocular diplopia. Difficulty reading YAG Capsulotomy Laser Service Often required post-cataract surgery

  10. Paediatric Ophthalmology Congenital cataracts Retinal problems Reduction in vision Red painful eyes Watery or sticky eyes Not oculoplastic or anything not listed below Squint/Strabismus/Ocular Motility (children) Squints- Constant squint needs prompt referral as risk of amblyopia/ underlying serious complaint i.e. retinoblastoma Restricted eye movements Double vision

  11. Oculoplastic (adults & children) Entropion/ ectropion (malposition of lids) Lumps and bumps on eyelid BCC or SCC (squamous cell carcinoma) of eyelid

  12. Squint/ Strabismus/ Ocular Motility (Adults) Squints Restriction in eye movements/ double vision Adnexal Watering eyes (complex lacrimal problems) Orbital problems Artificial eye/ socket problems General Ophthalmology Red eyes Signs but no symptoms Symptoms but no signs

  13. Hints and Tips • Double check that all attachments mentioned in the referral letter have actually been attached • Use the directory of services whenever possible to minimise the need for change of service this end – this may lead to a delay • Do not refer to a alternative clinic just to get an earlier appointment – this will cause a delay • Do not guess which clinic to refer to – this may also lead to a delay • Do not specify a particular Consultant as this will limit your access to the various clinics • Double check the patient’s address is correct on all correspondence • Practices do not need to refer patient’s from their copy of a diabetic screening report (BEH also get a copy and arrange appointment)

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