A PANDEMIC-INFLUENCED CARE MODEL COVID-19 HAS FORCED THE EYECARE SECTOR TO ESTABLISH NEW CARE MODELS THAT GIVE EQUAL CONSIDERATION TO TIMELY ACCESS AND SAFETY, AS ROYAL CHILDREN’S HOSPITAL MELBOURNE CHIEF ORTHOPTIST CATHY LEWIS WRITES.
S CATHY LEWIS
"WITH LIMITED PUBLIC HEALTH FUNDING, THE CURRENT CARE MODELS WILL STRUGGLE TO MEET THE INCREASED DEMAND ON SURGICAL WAITLISTS AND OUTPATIENT CLINICS"
ince the start of the pandemic, Australian eyecare providers have experienced many workplace challenges. The effect on service provision has varied according to the restrictions in place and patients’ clinical need and urgency, but finding a balance between the appropriate care timeframe and safety has been challenging. Melbourne has spent more days in lockdown than any other city and orthoptists and ophthalmologists at the Royal Children’s Hospital (RCH) Melbourne have become adept at the constant rate of change, implementing several initiatives, some outlined below. This has led to a positive work environment and patient experience, and improved collaboration with Orthoptist Navdeep Kaur in a RCH eye clinic tele-consult. Image: Alvin J Aquino/RCH Communications. external eyecare providers.
•C OVID-19 triage guidelines for outpatient eye clinics were implemented early on and are constantly adjusted according to the restrictions in place. These dictate whether appointments can be booked for face-to-face or telehealth. •T elehealth consults: Although not always ideal, tele-consults have become a permanent fixture. They provide an opportunity for parents to ask questions and receive advice, with an interpreter service included when required. The examiner can visually assess and observe the child and advise the family whether they should see an external eyecare provider while waiting for their face-toface RCH appointment. Interestingly, several families preferred tele-consults as travel time and the cost of face-to-face bookings were eliminated, while providing a calmer experience for children. • A Home Visual Acuity Test Kit and educational video was created early in 2020 to support tele-consults as there were limited resources to assist families with the home assessment. This is especially difficult for paediatric vision assessments when inducing crowding is essential for amblyopia detection and children often don’t know their alphabet. This was a time-consuming workflow as families were contacted and emailed a Home VA Test, matching card, instructions, recording sheet and link to the instructional video. Those without a printer were posted packs. The Home VA results were returned to RCH electronically and entered into the
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child’s electronic medical record (EMR) for reference during the tele-consult.
Approximately 11,500 patients are booked into the RCH eye clinic each year. This has remained stable during the pandemic, but the • e ye.clinic@rch.org.au email was created booking types changed. Tele-consults weren’t for communication between RCH, families, booked pre-pandemic, whereas 3,950 were and external colleagues as the need to comanage patients increased. This provided a booked in 2020 and 2,950 in 2021, with the pathway for all involved to exchange scans, pattern continuing in 2022. Although useful, results, and information. The RCH EMR also tele-consults cannot compare with in-clinic has a patient portal for direct communication examinations, resulting in a huge back log waiting for face-to-face appointments. In between the patient and staff. response, RCH increased the number and •M icrosoft Teams virtual daily huddle has types of orthoptist-led clinics which has been excellent for communicating daily been invaluable for service provision – and priorities, and just as importantly, enabling as we revise care models internally this may our team to feel connected. Running be expanded. Also, based on the success department meetings and internal CPD with LOEC, RCH will continue to investigate events virtually has enabled greater access additional options for co-management with for staff, the majority of whom are sessional, external eyecare providers. leading to increased participation. It will take time to fully understand • Co-management with external eyecare COVID’s impact on patients, but as it providers: Due to COVID, the waitlist to see continues, and with limited public health an RCH orthoptist increased and orthoptic funding, the current care models will student placements couldn’t be offered struggle to meet the increased demand on throughout much of 2020. In response, surgical waitlists and outpatient clinics, so La Trobe University (LTU) implemented a we must be innovative to ensure service student-led orthoptic clinic overseen by delivery is sustainable and timely. n an orthoptist (Latrobe University Orthoptic Eye Clinic - LOEC). The RCH collaborates by referring in patients from the orthoptic ABOUT THE AUTHOR: CATHY LEWIS is the Chief Orthoptist at the Royal Children’s Hospital Melbourne waitlist for co-management based on an and a casual lecturer in orthoptics at La Trobe University. agreed set of protocols. RCH has referred over 500 patients for co-management. As ORTHOPTICS AUSTRALIA strives for excellence a result, orthoptic students gain clinical in eye health care by promoting and advancing experience, RCH patients receive eyecare the discipline of orthoptics and by improving eye health care for patients in public hospitals, in appropriate timeframes while waiting for ophthalmology practices, and the wider an RCH orthoptist, and LTU surveys reveal community. Visit: orthoptics.org.au families are satisfied.
