Optimisation of outpatient resource utilisation in cataract management.
OBJECTIVE
We assessed whether patients referred with a diagnosis of cataract require outpatient assessment before listing for surgery or whether the general practitioner could have direct access to the waiting list. We also studied whether pre-assessment clinics made a significant difference to management even when waiting times were long.


METHODS
Data about patients referred with a diagnosis of cataract to the Oxford Eye Hospital and associated hospitals were collected. Seventy-five patients were prospectively studied and 100 patient records were retrospectively analysed.


RESULTS
Twenty-six per cent of patients had a misdiagnosis or additional problems affecting management. Optometrists provided more information than general practitioners, but their diagnostic accuracy was equal (73% optometrists, 75% general practitioners). At the pre-assessment clinic pupil dilatation changed management in only 4% of patients.


CONCLUSIONS
Listing patients on the basis of referral letters would be inappropriate in 1 in 4 patients. Pre-assessment clinics rarely picked up a clinically relevant change. Thus if outpatient consultation included a decision on the exact surgical plan including implant power, then pre-assessment clinics may not be necessary.
Oxford Eye Hospital, Radcliffe Infirmary, UK.
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S
Prasad
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V
Tanner
C K
CK
Patel
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P
Rosen
D002386:Cataract / Q000175:diagnosis*; D002387:Cataract Extraction; D003955:Diagnostic Tests, Routine; D017598:Efficiency, Organizational; D004739:England; D005194:Family Practice; D006801:Humans; D009907:Optometry; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration; D012189:Retrospective Studies; D014850:Waiting Lists