1. TARGET CONDITION Through judicious listing of cataract surgery (reduce input) and increase cataract surgeries output, we aim at reducing the notional waiting time to less than 30 months with <3 SOPD follow ups before operation (for routine cases). We also stratify the cataract waiting list to emergency (to be arranged by doctors asap), U1 (less than 2 months), U2 (less than 1 year) and NP (routine). We aim at achieving the target surgery delivery time in >80% of the patients. IMPLEMENTATION PLAN FOLLOW UP The cataract surgery out is planned to increase from: ActionResponsibleDeadline Expansion the OT appointment / calling serviceMr K Lee, Mr R Fung Expansion PAPDSr P Yim Establishment of Designated Cataract ServiceDr B Lam, Dr A Cheng Staff recruitmentHKEH Preparation of cataract screening criteriaDr L Wong, Dr A Cheng Reorganization of workflow in OTSr B Lun Coordination of workflow in SOPD / OTDr B Lam BACKGROUND With the aging of our population, there is an increase demand of cataract surgery service in HKEH. The notional waiting time for cataract surgery has exceeded 5 years in 2009. Concerns were raised by patients, society and staff on the long waiting time. The aim of this project: 1.To streamline the cataract surgery service in HKEH 2.To provide “on-time” cataract surgery for patients without compromising other services or staff training. CURRENT CONDITION Currently, when a patient comes to our SOPD with significant cataract requiring operation, he will go through the following process for cataract surgery Usually, patients require 5 SOPD follow ups before having cataract surgery. There is no guideline on the timing for cataract surgery for individual patient. For patients requiring “urgent / early” cataract operation due to medical or social reason, individual doctor will exercise their discretion for the timing of operation. PROBLEM ANALYSIS Long waiting list: Why? Large input to the list - Why? Aging population - Why? No definite criteria for listing - Why? Many patients not in the catchment region - Why? Patients preferred to stay in HKEH / not keen to be referred out Why? Difficult to increase cataract output - Why? Operating theatre cannot be fully utilized - Why? Lack of OT nurses and doctors (need to cater for other services, e.g. SOPD load) - Why? Supporting service (e.g. PAPD, IOL calculation) inadequate to cater for increase service - Why? Increasing amount of workload for competing subspecialty services - Why? 4 cataract surgeries per session - Why? Need to fulfill the high standard of infection control and documentation - Why? Need to cater for training of junior doctors - Why? Significant proportion of “difficult cases” (as a tertiary referral centre) Title: Model of Care for Cataract Surgery in HKEH Leaders: Dr Ben NM Lam, Dr Andy CO Cheng Sponsors : Dr Derrick KS Au, Dr Stanley CC Chi Facilitator: Dr Andy CO Cheng Members: Dr Amy L Wong, Sr Brenda Lun, Sr Deborah Ng, Sr Phyllis Yim, Mr Keith Lee, Mr Ryan Fung Start Date: Jul 2009 End Date: Dec 2011 Last Updated: Nov 2010 ID: SOPD listing Treatment room for BP, H’stix Surgery appointment counter SOPD follow up PAPD Surgery PAPD SOPD listing Surgery appointment counter Surgery appointment counter Surgery SOPD Follow up YearNo. of cases 2008-094000 2009-104700 2010-115200 2011-125700