In December 2021, we had significant capacity challenges within paediatric ophthalmology.
Previously all patients wanting to discuss squint surgery would be seen on a consultant clinic by an orthoptist for measurements and then a consultant for listing decision and discussion. As there were no consultant clinics for them to be seen there was a large backlog of patients not getting seen for surgical listing. To tackle this we used the opportunity to develop a pathway delivered by advanced orthoptists to list patients on a specialist clinic rather than having to wait to see the consultant.
The pathway involved the orthoptist undertaking consent training and notes reviews with the consultant
We then used these results to develop guidelines and a protocol for a suitable cohort of patients that could be effectively managed on these clinics. The objective was that the advanced orthoptist would see the patient to decide if they were appropriate for squint surgery and discuss the aims, risks and effects without the need for seeing a consultant
The main aim and primary outcome of this new pathway was to reduce the waiting time for paediatric patients waiting to be listed for squint surgery at the Newcastle Eye Centre
All paediatric patients wanting to discuss squint surgery were booked onto the squint listing clinics to see the advanced orthoptist
We reviewed the notes on Medisoft and Powerchart of all patients seen on this clinic from December 2021 to December 2023
257 patients were seen on these clinics over the 2 year period which is 257 consultant clinics slots saved – allowing more urgent patients to be seen . Since January 2024 we started listing patients in real time using this new pathway – primary aim was reduced by 50% from 26 weeks to 13 weeks once the orthoptist started listing in real time.
We aimed to give patients a post-op satisfaction questionnaire at first visit post-op.
Received 42 questionnaires with 98% being happy with the pre-op information received and 100% satisfaction with the information leaflet
81% felt the waiting time for squint surgery was acceptable and 98% were satisfied or highly satisfied with the overall experience.
The majority of patients (81%) were able to be listed by the orthoptist for squint surgery
The results from this service review show that orthoptic-led paediatric squint listing clinics can provide safe and effective specialist care, whilst alleviating pressures on the service and allowing more urgent conditions to be seen by consultants.
We have used this service review to develop and expand listing practice into other areas of paediatric ophthalmology to help with the ongoing capacity demand challenges such as listing for lacrimal probing and chalazion removal procedures.
