New guidance to help teams deliver more high flow cataract surgery to tackle waiting list backlog

cataract hub guidance Jan 2022

Guidance for developing effective hubs for most types of cataract surgery have been published by the Royal College of Ophthalmologists (RCOphth) in partnership with GIRFT, to help health systems deliver more sight-saving operations and better tackle the waiting list backlog.

The High Flow Cataract Surgery guidance, available on the RCOphth website and in the GIRFT Academy Best Practice Library, highlights practical steps for developing high flow cataract services within hospitals, using best practice case studies to illustrate where teams have achieved success. It demonstrates how the key principles that underpin high flow operating can be applied to suitable complex cases as well as less complex ones, and whether the hub is in a hospital or a standalone unit.

It updates March 2021 joint guidance from the RCOphth and GIRFT on setting up cataract hubs, which was based on work carried out in London to establish high volume low complexity (HVLC) sites – sometimes known as high flow low complexity (HFLC) sites – across six surgical specialties. The HVLC work, led by GIRFT working with the regional NHS England and NHS Improvement team, resulted in one or two cataract hubs being established per system, with hub teams working to standardised high flow processes.

The latest guidance incorporates further learning which has since emerged from other regions and the evolution of the London hubs, showing how mixed lists (both routine and complex cases) and complex-only lists can also benefit from many of the high flow principles.

Taking a whole pathway approach, the document offers advice on each stage of the patient journey – from the pre-hospital stage to post-surgery discharge – as well as looking at how high flow surgery can be supported outside the cycle of care.

It is hoped the guidance will help teams to restore surgical activity for cataracts to better than pre-COVID levels, in line with the NHS elective recovery plan. There are an estimated 600,000 patients now waiting for their first ophthalmic outpatient appointment, and analysis by NHSE’s National Eye Care Recovery and Transformation Programme (NECRTP) shows that, without activity rising well above business as usual, it will take more than five years to clear the backlog.

Download the High Flow Cataract Surgery guidance here.

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