PEATS Mr. Bal Manoj Consultant Ophthalmologist The Royal Wolverhampton Hospitals NHS Trust

PEATS - Purpose Provide appropriate triaging of both acute and non-acute referrals by trained and accredited community optometrists Treatment of minor eye conditions (e.g. red eyes which cannot be managed by the GP) Minor procedures (e.g. corneal foreign body removal)

Where referral to secondary care from PEATS is required, it should be to a suitable specialist with appropriate work-up, initial diagnosis and urgency

Participating PEATS optometrists have received a document, listing which conditions are appropriate for assessment and/or treatment under PEATS, and those which need to be excluded from PEATS and referred to the emergency eye clinic (New Cross Hospital ARC) the same day.

WHY PEATS??? To reduce the workload at the Hospital Casualty and Acute Referral Centre (ARC) Optoms to manage most patients in the community Only refer appropriate cases to HES

ULTIMATE GOAL No patient presents to Casualty with eye problems – all seen by PEATS optoms. ARC only sees patients triaged by PEATS optoms.

What to refer? Nothing……

What to refer? Urgent - to be seen within 24 hours Semi-urgent < 72 hours Routine – in clinic ****** - Manage as much as possible in the community

WHAT TO REFER ?? Common sense approach Focus on symptoms and duration Don’t agonise on the diagnosis

URGENT REFERRALS Painful red eye Corneal ulcer Anterior uveitis Corneal FB Acute angle closure Chemical Injury

URGENT Sudden recent (<48 hrs) loss of vision Retinal detachment (includes retinal tear with no RD) CRAO (<12 hrs old) Optic Neuritis / AION Unexplained sudden loss of vision URGENT REFERRALS

URGENT Papilloedema Orbital cellulitis Penetrating Injury URGENT REFERRALS

Conditions for ARC Referral that should be seen in <72 hrs Loss of vision (<1/12 duration) CRVO / BRVO Macular hole CSR Optic neuritis / AION Recent onset binocular diplopia PVD related symptoms with pigment in vitreous (<1/12) Vitreous Hge (recent onset)

Macula Fast-Track Referral Wet macular degeneration with signs/symptoms that fit the fast track criteria

“Suspected cancer” referrals Periocular Tumours Basal cell carcinoma Squamous cell carcinoma No change from the current pathway. Refer as “urgent” to the oculoplastics clinic ?via GP Intraocular tumour (eg melanoma) – Refer to ARC to be seen within 72 hours

WOLVERHAMPTON PEARS AUDIT - LESSONS