Out of hours ophthalmic surgery: a UK national survey.
OBJECTIVE
There have been significant changes in the management of out of hours services in ophthalmology recently. The European Working Time Directive (EWTD) and economic measures have anecdotally reduced the availability of staff and facilities outside normal working hours, and there have been various responses to the provision of emergency surgical care. There are disparate attitudes to the optimum management of the emergency surgical case. We sought to establish a nationwide picture of the management of out of hours surgery.


METHODS
A questionnaire was distributed to every consultant ophthalmologist working in the NHS and registered with the Royal College of Ophthalmologists (n=947). Information was requested regarding departmental and personal policies, local facilities, and personal beliefs regarding emergency surgery.


RESULTS
A total of 440 (46.5%) questionnaires were returned from 155 units; 18.7% of the units had no out of hours services or no operating facilities. Sixty-three percent of units reported a local policy regarding a time after which patients should not be taken to theatre. For 57%, this time began between 2100 hours and midnight. The most common reasons for not operating after a certain time were 'belief that delay does not significantly affect the outcome' (41.6%), 'delayed access to theatre due to competition with other surgical specialities' (40%), and 'no specialist ophthalmic-theatre nursing input' (32.7%).


CONCLUSIONS
We report the first nationwide study on out of hours ophthalmological surgical working practices. This demonstrates variation in work patterns. It is significant to patients and ophthalmologists that there should be units in United Kingdom without full local facilities and staff.
Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee, UK. uocolmain@nhs.net
U
U
O'Colmain
M
M
Wright
H
H
Bennett
C J
CJ
MacEwen
D039602:After-Hours Care / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005062:European Union; D006302:Health Services Research; D006801:Humans; D013508:Ophthalmologic Surgical Procedures / Q000706:statistics & numerical data*; D009885:Ophthalmology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013222:State Medicine; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014940:Work Schedule Tolerance