Eye casualty services in London

Area of Science:

• Ophthalmology
• Healthcare Management
• Public Health

Background:

• European Working Time Directive, 4-hour waiting targets, and rising unplanned attendances have led to eye casualty department consolidation.
• Remaining eye casualty services face rapidly increasing patient demand.
• This study examines the impact of these changes on emergency eye care provision in Central London.

Purpose of the Study:

• To analyze the effects of eye casualty service consolidation on emergency eye care delivery in Central London.
• To identify lessons learned from service consolidation for wider application.
• To propose strategies for managing increased demand and improving patient pathways.

Main Methods:

• Survey of managers from 8 out-of-hours eye casualty services in London.
• Analysis of attendance data from key London eye units.
• In-depth interviews with lead clinicians at major eye casualty departments.

Main Results:

• Annual attendance at Moorfields Eye Hospital and Western Eye Hospital increased by 7.9% and 9.6% respectively.
• Service consolidation resulted in patients traveling longer distances to potentially inappropriate units.
• Confusion arose regarding out-of-hours inpatient care responsibilities.

Conclusions:

• Increased demand necessitates strategies to enhance capacity and efficiency in emergency eye care.
• Service consolidation can lead to unintended consequences like increased patient travel and unclear responsibilities.
• A novel referral pathway was developed to minimize patient travel and delays, with a call for strategic planning of London's eye casualty services.