The Brighton & Hove Age Related Macular Degeneration (AMD) pilot project
End of project conclusion and recommendations
1. Benefits
The pilot project has brought about the following benefits to patients, staff and the local Hospital Eye Service (HES):
- A structured fast-track referral protocols for AMD patients.
- A shorter waiting times for AMD assessment appointment.
- A dedicated and one-stop AMD assessment clinic for patients with AMD.
- Identification of and engagement with a cohort of community optometrists who undertook specialist training to become Community Optometrist with a Special Interest (COSI).
- A more defined and pro-active role of the Eye Clinic Liaison Officer (ECLO) in the Eye Hospital. Funding from this project has helped to consolidate the role of ECLO in the care of HES patients, bridging the care and service provided between HES and Social Services.
- Opportunity to develop extended skills among ophthalmic nurses.
- An integrated and streamline network of service and social support for people with AMD throughout the pathway.
- A community-based integrated Low Vision and Rehabilitation Clinic which helps to promote greater independence among our patients.
- Greater awareness of support network available for all stages of AMD patients.
- A closer working relationship between the Primary Care Trust (PCT), HES and Social Services.
2. Lessons learned
- Knowledge of PRINCE2 methodology is paramount to give the project a firm and solid start.
- When more than one organisation is involved in the project, it is important to ensure that key representatives from each organisation are highly motivated and supportive of the project.
- Keep the management & clinical team of the Hospital regularly informed of the progress of the project especially at the development/initiation stage.
- Dedicated project management time/resource is essential in ensuring project work is undertaken and completed.
- Keep lines of communication open with all frontline staff (eg through informal chat, clinic visit etc) to address any of their concerns and to keep them motivated.
- When there is good news to share, make sure that all are informed to keep the team motivated.
- Keep in contact with other project managers by seeking their advice or sharing ideas with them. Avoid reinventing the wheel.
- Be realistic with the timescale in the project plan.
- Inform the NHS Eyecare Services Programme immediately when problems/issues arose within the project.
- Be generous with commendation to staff directly involved in the project.
- Personal visit to optometry practices was effective in gaining support for the project. In addition, it provides the opportunity to address any concerns raised by the optometrists immediately.
- Structured feedback to COSI re their referrals are important to their ongoing training in making accurate diagnosis.
3. Recommendations
- Future monitoring of COSI referrals through data collection to be undertaken by PA of ECLO in co-operation with Consultant Ophthalmologist’s medical secretary.
Monitor the referral quality of COSI through modifying the HES referral criteria in various stages. Presently, based on the data analyses collected during the pilot period, it was agreed with the Ophthalmologist that the COSI use the following modified referral criteria:
- Age-Related Macular Changes (AMC): No HES referral needed. Patients to be monitored by COSI/CO
- Dry AMD with VA better than 6/18: No HES referral needed.
- Patients can be referred directly to LVC, if needed, via ECLO.
- Dry AMD with VA 6/18 and worse: HES referral.
- Suspect wet and wet AMD: HES referral.
- Need to provide periodical follow-up training (6 monthly) to COSI. This can be arranged by Consultant Ophthalmologist through his Retinal Fellow.
- There is a need to monitor the suitability and benefits of the low vision aids provided through Low Vision Aids (LVA) questionnaire.
4. Conclusions
The aim of this project was to develop an integrated eyecare service pathway for patients with AMD to ensure prompt, effective and patient-centred care.
We have successfully achieved the aims of the project by training a small group of strategically located COSI to triage AMD in a community setting, by establishing rapid referral protocols between COSI and HES, by setting up a one-stop AMD assessment clinic and by providing a streamlined low vision and rehabilitation support which is co-ordinated via ECLO.
This integrated care pathway has greatly benefited AMD patients in Brighton & Hove as supported by the responses of the patient satisfaction survey.
January 2007