Best Ophthalmology Team

Teamwork is critical in the delivery of high-quality ophthalmology care. A healthcare system that supports effective teamwork can improve the quality of patient care, enhance patient safety and reduce workload and capacity issues that cause unnecessary stress among healthcare professionals and patients. This honour is given to an ophthalmology team who deliver and sustain an excellent level of patient care by working together to achieve goals.

Honouree

University Hospitals Birmingham NHS Foundation Trust
The Uveitis Service – Building a holistic personalised service for patients with sight-threatening inflammation

Uveitis – inflammation within the eye – is a major cause of blindness in the working age population. Its complexity means that care in non-specialist clinics is difficult, delaying diagnosis and reducing access to modern NICE-approved treatments.

Honouree - The Uveitis Service - Building a holistic personalised service for patients with sight-threatening inflammation - University Hospitals Birmingham NHS Foundation Trust

The University Hospitals Birmingham NHSFT established the Uveitis Service in 2012 and is now providing tertiary-level care across South Birmingham and surrounding region, and quarternary-level care for rare uveitis syndromes (e.g. Birdshot Chorioretinopathy and Punctate Inner Choroidopathy).

The aim of the Uveitis Service is to provide excellence in care for patients with uveitis through quality of care, patient safety, positive patient experience and a culture of research and innovation. The service has been developed with strong patient engagement and the multi-disciplinary team brings together staff with a wide range of skills, who work with the service users to improve uveitis care in line with patient-identified priorities.

To develop an exceptional level of staff motivation, patient engagement and shared ‘ownership’, the team has invested in education and staff development. The Clinical Lead meets weekly with all team members one-to-one, reviewing clinical queries and exploring opportunities to improve the service and the education opportunities. Clinics are preceded by a ‘team brief’ to prepare and review case histories, and all patients with active problems are discussed and/or reviewed with the Clinical Lead. Non-clinical team members are also given opportunities to attend the clinic to understand patient needs. Particular emphasis is placed on ensuring that all members know that their voice counts, understand their essential contribution to delivering excellent care and have ready access to the Clinical Lead. Patient–staff engagement is also promoted through quarterly meetings with the local patient group (PInGU), co-production of educational resources and co-fundraising.

Easy access to advice and review is achieved via a uveitis helpline and rapid response email for clinical/admin enquiries. The ‘Team brief’ and one-to-one meetings also provide excellent communication across the service. The stable and committed team of consultants, clinical nurse specialist, clinic nurses, technicians, secretary and manager, guarantees continuity of care and aims to create a caring environment in which patients know that they are valued – a result reflected by the excellent patient/support group feedback, social media reviews and ‘Friends and family’ test. Patients with rare uveitis syndromes particularly value the condition-specific clinics where they can meet others with the same condition. Clear and appropriate explanations regarding the condition and its treatment are provided to patients through the face-to-face consultation and additional educational materials. Patients are also involved in all treatment decisions.

The team aims to provide a safe immunosuppression service that respects the ‘real-life’ needs of patients, audited against national guidelines and with high safety standards. The University Hospitals Birmingham Uveitis Service is an NHSE-prescribing-centre and uveitis clinical trial centre, providing early access to the latest treatments. All patients and staff are given opportunities to develop/improve the service and engage in research: over 1,400 patients have been enrolled since 2012, leading to over 60 research papers from the Uveitis Service with over 30 different team members represented as co-authors.

The success of the Uveitis Service is measured against specific objectives, and these aims are continually reviewed to ensure the service adapts to a changing NHS/societal environment. This is achieved through consultation with patients, identifying unmet local/regional needs for uveitis care with clinical experts/patient groups and reviewing best practice around the UK. Continuous audit/multi-stakeholder feedback also shows that the service provides a high-quality, safe service that is aligned to the needs of patients.

Why this was chosen

“An inspirational best practice highlighting an excellent multi-disciplinary service, a cohesive team and clear results in setting up this complex speciality. A lot of effort was put into the team construction, with a strong commitment from the clinical lead to meet weekly with all team members.”

Key learnings

  • Value the ‘patient voice’ and align services as far as possible to patient priorities
  • Involve patients to help better deliver the service – the most impactful educational events are when patients are invited to tell their stories to the whole team
  • Ensure every team member understands their role and why it matters to delivering excellent care
  • Ensure every team member feels valued
  • Invest in staff development for every team member
  • Consider stratifying clinics – separating clinics for highly complex patients can improve quality, safety, patient experience and can help peer-to-peer support
  • Keep listening and be open to feedback

Highly commended

Royal Group of Hospitals, Belfast Health and Social Care Trust
Neuro-Ophthalmic Visual Impairment in Children (NOVIC) – a multidisciplinary service for children with sight impairment due to neurological dysfunction

NOVIC (Neuro-Ophthalmic Visual Impairment in Children) is a multi-disciplinary collaboration between the Royal Victoria Hospital, Belfast (RVH), the Royal Belfast Hospital for Sick Children (RBHSC) and RNIB. The team comprises individuals with paediatric expertise spanning the visual, neuro-developmental and psychosocial sectors.

Highly commended - Neuro-Ophthalmic Visual Impairment in Children (NOVIC) – a multi-disciplinary service for children with sight impairment due to neurological dysfunction - Royal Group of Hospitals, Belfast Health and Social Care Trust

Children with Cerebral Visual Impairment (CVI) have complex developmental and health problems. In the past, families were often advised that their child had vision loss beyond the remit of intervention. The NOVIC team provides a dynamic picture of their child’s vision, addressing visual, neurological, daily living, social and emotional needs at one visit.

During the appointment, the orthoptist, optometrist and ophthalmologist endeavour to quantify visual acuity, field and assess ocular movements, refractive and accommodative status, binocularity, ocular health and the need for intervention. Physical and neuro-developmental assessment with the paediatric neuro-disability registrar and occupational therapist addresses general health, medication, seizure activity and management of daily activities. Finally, the Eye Clinic Liaison Officer (ECLO) discusses Visual Impairment Certification, RNIB initiatives and access to community services, while providing emotional support.

The visit concludes with the team delivering a combined impression of the child’s visual capabilities and strategies to enhance these to families. ‘Take home’ bags of visual and tactile stimulatory resources and patient information donated by RNIB are distributed.

A personalised report is later provided and copied to all professionals involved in the child’s care.

NOVIC findings have informed assessments for educators and housing provision to maximise children’s educational potential, mobility and activities of daily living.

All team members have developed expertise ‘on the job’ and are committed to attend and deliver educational initiatives on paediatric CVI. The NOVIC clinic database is a wealth of information for research and audit. Medical students, junior doctors, orthoptists and vision support teachers attend NOVIC to learn and impart their experience.

Why this was chosen

“A very complex multi-disciplinary team addressing an important eye condition that is often neglected. This small dedicated service has adopted an innovative, holistic approach that plugs a gap in the service for these children, and is a best practice with the potential to be replicated.”

Key learnings

  • The visual function of children with profound neurological abnormality can be enhanced with tailored strategies - modifying circumstances, surroundings and interactions with these children. Professionals and carers should be encouraged to support them to fulfil their potential
  • The team continues to seek funding for this service, in particular for a play therapist, psychologist and physiotherapist, as well as an assessment area to look at children’s navigational abilities and perceptual skills
  • Cerebral Visual Impairment (CVI) is most appropriately managed by a multi-skilled team and NOVIC has successfully deployed a model of multi-disciplinary care, focusing on the whole child and their family, with understanding their vision at its heart

Commended

Barts Health NHS Trust
The London Retinoblastoma Unit: saving sight and saving lives of children

The London Retinoblastoma Unit is one of two national centres in the UK.

Retinoblastoma (Rb) is the most common eye cancer in children and management requires the expertise of a multi-disciplinary team working cohesively to make prompt decisions about life- or sight-saving treatment and to deliver high standards of care.

Commended - The London Retinoblastoma Unit - saving sight and saving lives of children - Barts Health NHS Trust

The core team is led by two consultant ophthalmologists and consists of three paediatric oncologists, a specialist orthoptist, a play therapist, two specialist oncology nurses, a psychologist, two clinical fellows and one administrator. In addition, input from two histopathologists, a clinical geneticist, a dedicated genetics unit and a representative from the Childhood Eye Cancer Trust (CHECT) are valued at multi-disciplinary team meetings.

Every service meeting includes safety issues, clinical effectiveness and complaints/compliments. Every year, the team meets their Birmingham counterpart (the other national retinoblastoma centre) for benchmarking and best practice sharing.

Theatre lists have input from the play specialist (who knows how each child reacts to the anaesthetic) and include bespoke consent forms and safety checks. In a single day, the team treats 16 cases under general anaesthesia (a volume normally associated with local anaesthetic procedures such as cataract surgery).

A psychologist offers behavioural understanding and support to patients and families, including siblings, while the play therapist runs a monthly Eye Club that empowers children to teach younger patients how to care for their prosthetic eye, helping to reduce stigma.

The service has a five-year Rb patient survival rate of 98%. In advanced Rb, the eye is now salvaged in 63% of cases and the enucleation (eye removal) rate has reduced from 60% (2011-2016) to 37%. Patient services consistently show greater than 90% satisfaction / high satisfaction.

Why this was chosen

“A team that has achieved striking results, in particular in terms of survival rates, and has shown great progression in a specialised service requiring excellent team work.”

Key learnings

  • Team members (e.g. play specialist) are empowered to undertake innovations and provide a holistic approach and the integration of Childhood Eye Cancer Trust (CHECT) into the team improves transparency and patient experience
  • Children are empowered by sharing their stories with other younger survivors. Psychological support is provided and communication routes are simplified using information guides to reduce parental anxiety. Teachers and carers are also educated to support children
  • High output research is produced and international observers from ten countries (high and low resource) are hosted. The London Retinoblastoma Unit alumni now lead ocular oncology services in six international centres
  • Retinoblastoma services are also supported in countries where the survival rate is poor and the team’s work has had a dramatic effect on compliance with eye removal in Zimbabwe

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