Remote consultations to reduce hospital and primary care visits for urgent eye care services

Moorfields Eye Hospital NHS Foundation Trust is one of the largest providers of ophthalmology services in Europe, seeing around 800,000 outpatients per year. It runs a large walk-in A&E service at its main central London site, seeing around 100,000 patients per year.

Situation

The COVID-19 pandemic led to the suspension of elective eye care services, creating major issues:

1. Identifying and managing the most critical emergencies, whilst minimising hospital visits.
2. Managing follow-up patients who may come to harm without clinic appointments.
3. In addition, COVID-19 created a need to minimise face-to-face appointments for lower-risk urgent or acute cases, including patients who walked into Moorfields or could not access care at their local eye unit.
   

Aspiration

To create a remote consultation service to triage and give advice and guidance directly to patients so that hospital and primary care visits can be avoided if appropriate.

Solution and impact

To address these issues Moorfields Eye Hospital decided to launch two remote consultation clinic models with the Attend Anywhere (AA) video consultation platform:

1. Drop-in video consultations - Moorfields runs (in normal times) a walk-in A&E service without appointments. Similarly, for the video consultations, patients do not need an appointment. They can access a virtual waiting room 9am to 5pm, Monday to Friday and at specified times over the weekend via a link on the Moorfields website.
   
   The service was initially staffed by up to five ophthalmologists (consultants, trainees, staff grades) who participated in a daily rota. Some of these clinicians were self-isolating at home or shielding, while others were drawn from staff redeployed from other services.
   
   Where subspecialty input was needed, this could be achieved by inviting the on-call consultant as an additional clinician to join the Attend Anywhere consultation by mailing them the link using the button from the AA screen, or via offline discussion. This service was further enhanced by deploying a secure clinical messaging app to improve communication between clinicians performing the video consultations remotely and staff in the hospital.
   
   
2. Scheduled, invitation-only video consultations - Patients are contacted by phone, email or SMS with an appointment time. They are given guidance about requirements for a video consultation and how to join the virtual waiting room.
   

Documentation of video consultations is entered on the Trust electronic patient record (OpenEyes), and letters sent to the GP and patient, as would happen for in-person consultations. Specific clinic codes are generated for video consultations on the patient administration system (PAS).

Moorfields is now the second largest acute trust provider of video consultations, and fourth heaviest user of Attend Anywhere, with more than 15,000 consults since launch in March 2020. The service was advertised by social media, switchboard operators, and the hospital’s website. Referring GPs and optometrists were also made aware. Usage, successes and encouragement to be involved were communicated frequently as part of the Trust’s COVID-19 staff communication plan.

A&E sees around 100 patients each day, with over 15,000 patients receiving care via A&E or booked clinics. Of the first 331 patients to use the A&E service, 78.6% were able to avoid a hospital visit. Patient satisfaction has been assessed in our adnexal services, with 62% of patients preferring video consultation over face-to-face, and 92% saying they would recommend the service. Patients spend less time waiting for their consultation and do not lose the time usually spent travelling (though some may have to visit hospital if the clinician feels this is necessary following video consultation).

Audits have demonstrated the clinical safety of video consultations at Moorfields if they are embedded within well-defined pathways with appropriate access to escalation.

Functionality

• Attend Anywhere is a secure digital video consultation system
• Video consultations allow patients to access care from home without needing to attend hospital
• The Attend Anywhere platform is used in many medical specialties and ophthalmic units
  

Capabilities

• Secure video consultation device and software
• It has been made available free to all English trusts for one year from April 2020
• Assistance and advice are available from Attend Anywhere
• Runs entirely on a web browser, allowing patients and clinicians to sign in from anywhere
• Able to embed video call access into websites, existing systems, workflows and patient pathways, or existing software
  

Scope

• Remote consultations and communication between patients and clinicians can be performed
• Supports second opinions
• It can support communication from clinician to clinician with the potential for shared care if two clinicians join the live consultation with the patient
  

Key figures/quotes

78.6% of patients attending the video triage service in Moorfields A&E were able to avoid a hospital visit

Find out more

Download further information from the Moorfields case study (PDF, 182 KB)

Download further information on Moorfields’ use of video consultation (PDF, 2.4 MB)

Learn more about oculoplastic telemedicine

British Medical Journal has more details on the implementation of Moorfields’ virtual eye clinics

Key contact

Peter Thomas, director of digital innovation and consultant paediatric ophthalmologist, Moorfields Eye Hospital

peterthomas2@nhs.net