OPTIMIZATION OF OUTPATIENT RESOURCE UTILIZATION IN CATARACT MANAGEMENT

Purpose We assessed whether patients referred with a diagnosis of cata ract require outpatient assessment before listing for surgery or wheth er the general practitioner could have direct access to the waiting li st. We also studied whether pre-assessment clinics made a significant difference to management even when waiting times were long. Methods Da ta about patients referred with a diagnosis of cataract to the Oxford Eye Hospital and associated hospitals were collected. Seventy-five pat ients were prospectively studied and 100 patient records were retrospe ctively analysed. Results Twenty-six per cent of patients had a misdia gnosis or additional problems affecting management. Optometrists provi ded more information than general practitioners, but their diagnostic accuracy was equal (73% optometrists, 75% general practitioners). At t he pre-assessment clinic pupil dilatation changed management in only 4 % of patients. Conclusion Listing patients on the basis of referral le tters would be inappropriate in 1 in 4 patients. Pre-assessment clinic s rarely picked up a clinically relevant change. Thus if outpatient co nsultation included a decision on the exact surgical plan including im plant power, then pre-assessment clinics may not be necessary.