HSE shared care ophthalmology service protecting people’s sight

Nursing services at the Royal Victoria Eye and Ear Hospital (RVEEH), Dublin, are improving access to integrated eye care for patients, protecting people’s eyesight while reducing waiting times for ophthalmology services by managing stable chronic patients in a controlled environment.

The HSE is highlighting key figures from the RVEEH nursing services, who managed 13,762 ophthalmology patient visits independently and 908 patient visits as part of a shared care clinic in 2023, an increase of 217% from 2019.

The eye conditions managed include some of the main causes of blindness in Ireland, such as age-related macular degeneration, glaucoma, and cataracts with nursing also supporting ocular emergency, cornea and oncology patients.

Key 2023 data shows:

• 9,965 of all injections to patients for the management of their eye condition were administered by nurses
• Only 12% of patients attending the nurse glaucoma clinics required follow-up with a consultant
• Patients have indicated almost 100% satisfaction with the nurse-led service.

The service optimises access to care, reducing waiting times and ensuring continuity of care, as patients often see the same staff member at each visit. Using innovation, digitalisation and an integrated team approach, it is a key example of healthcare reform as it affords medical colleagues the opportunity to see more complex patients.

Cathriona Ennis, Director of Nursing, Royal Victoria Eye and Ear Hospital said: “The nurse-led service in RVEEH improves access to care and timely diagnosis for patients. Nurses are supported in a culture that empowers them to practise at the top of their licence and are instrumental in reducing the risk of disease progression or preventable blindness. The multidisciplinary approach optimises medical capacity, enhances the patient experience and designs a service that is built on robust governance, competency-based training, evidence-based outcomes best practice and patient & staff feedback.”

Integrated Eye Care Teams in the community are being rolled out to deliver specialty services including assessment, prioritisation, diagnoses and pre-op or post-op care. In line with Sláintecare, the RVEEH clinic is also referring patients to community-based services. For example, the community health teams in Tallaght, Wicklow and Churchtown looked after 7,899 new and review patient episodes closer to home in 2023.

Shared Care Initiative

A shared care refers to a collaborative and well-monitored care plan designed to promote coordinated care for individuals with chronic diseases by facilitating communication between healthcare teams and patients as well as across different healthcare providers and over time.

Linda Fabbian, a Clinical Nurse Specialist (CNS) in glaucoma ophthalmology, has been supported by the Advanced Nurse Practitioner and lead consultants on a pilot basis to expand her role to meet the needs of the community population. “My role involves monitoring and treating patients with glaucoma and assessing patients after cataract surgery. The community care pathway ensures the right patient gets the right care at the right time, improving access to care for patients. This removes the need for some patients to be seen on the hospital site.”

Deirdre Bannon, a 78 year old widow from Tallaght, is delighted to be able to attend the RVEEH nursing services, based in Kilnamanagh/Tymon Primary Care Centre. Speaking about her positive experience, Deirdre explained how she was diagnosed with glaucoma several years ago after she was screened for pressure in her eye Following an initial examination, Deirdre was referred to the Royal Eye and Ear Hospital for further treatment.

“While attending my regular appointment in the Eye and Ear Hospital in January 2024, I was offered an outpatient appointment at Kilnamanagh/Tymon Primary Care Centre, which is a local clinic near my home in Tallaght.  The nurse asked me if I would like to go along there for my appointments. I jumped at the chance as it was so close to where I live. The care is amazing. They keep a good eye on me and it’s such an added bonus to have my care locally in Tallaght,” Deirdre added.