Evening Clinics

Who does do all the work?

Mr Andrew Plumb
Mfazo Hove
Claudia Ban
Introduction
• Government target : All new patients
to be seen within 13weeks of referral
by March2004.
• In the second quarter of 2003 East
Sussex Hospitals received 3563 new
patient referrals.
• Brighton and Sussex University
hospitals received 2129.
• Of the 2257 written by GPs 1567
(69.4%) were seen in 13 weeks.

www.doh.gov.uk/waitingtimes/2003/
• A further 205 (9.1%) were seen after
waiting 13-17 wks and 255 (11.3%)
after 17-21wks.
• Clearly to meet the government
target more new patients have to be
seen quickly.
• Enter : Evening New Patient Clinics
• This would increase our capacity to
see new patients and help
accomplish our target
Evening Clinics – The Ethos
• Run by Associate Specialists
and Staff Grades
• Supposed to be one stop shop
allowing patients to feed into
other existing services
• Patients for these clinics are
selected specifically
• Cost efficient to establish as
infrastructure and staff already
exist.
The Conundrum

• Unless all patients seen in the

evening clinics are discharged, their
addition to the various waiting lists
must create more work and longer
waiting lists.
• How much more work & for whom?
• Are we providing a better service for
our patients?
The audit - method

• “Retrospective review” of
current practice as opposed to
true audit.
• Identified first 10 evening
clinics
• Traced available case notes
from these clinics
• Reviewed case notes.
Results
• 63 sets of notes reviewed out of a
possible 100.
• All available notes were reviewed.
• 11 patients did not attend their
appointments. Higher rates of DNAs
possibly due to time of appointment.
• Lots of patients requested re-
scheduling of appointments to avoid
evening clinic.
 Diagnoses

18
16
14
12
10
Series1
8
6
4
2
0
NAD

BCC
ARMD

Posterior
Ambylopia

Diabetic
Cataract

Meibomian

Other diagnoses: (n=1 each)

Dry eyes, Trichiasis, Congenital Toxoplasmosis, Entropion,
Choroidal naevus, Ectropion, Glaucoma, Scotoma,
Keratoconus, Congenital cataract, Tear film instability,
Cluster headaches, Stenosed puncti, Xanthelasma,
Concretions, Blepharitis,
 Cataract
Procedures generated
3 snip
20
18
16 Yag capsulotomy
14
12
10 Entropion Correction
8
6
4
2 Laser Trichiablation
0
Minor op
Trichiablation
Cataract

BCC excision
Yag capsulotomy

Removal/curretage of
Laser

cysts
Minor op

Ectropion Correction

BCC excision
 Followups generated

30 Medical Clinic
25
Orthoptists
20
15 Low visual aid
10
Casualty
5
0 Photography

Visual fields

Contact lens
clinic
Discussion
• Approximately every three
patients seen in evening clinic
generates 1 cataract operation,
1 minor operation and 1 general
clinic appointment.
• 63 patients generated over 100
dictated and typed letters.
• 13 out of 63 patients were seen
and discharged on the day of
clinic.
• Three of the five orthoptist
appointments were double
appointments to assess
diplopia.
• The casualty appointments
were as a result of patients who
had minor ops attending for
complications.
The Implications
• Clearly evening new patient clinics
increase access to the services provided
by the ophthalmology department.
• They also increase the amount of work
done by all the staff.
• This extra work however may adversely
affect performance if the services are
already stretched to capacity.
• Achievement of the government target of
seeing new patients within 13 weeks of
referral will involve planning to increase
capacity across the range of staff
employed in the department.
• There is currently a huge
backlog of minor ops which
could provide an excellent
learning opportunity for SHOs if
adequately supervised.
• Training of nurses to do IOPs
could potentially increase
capacity in general clinics.