“The well-being of our colleagues must remain an absolute priority”

Dr Waheeda Illahi, Rosie Auld, Dr Emma Berrow and Dr Peter Good from Birmingham and the Midland Eye Center on the Delta variant, COVID-19 fatigue and backlog management in the field

Waheeda and Emma

The Delta variant of COVID-19 poses a potential risk of a third wave in the UK as the rate of transmission increases within the community. As Heads of Service (HoS) at Birmingham and Midland Eye Center (BMEC), we are not afraid of the looming wave, but rather weary of the consequences. From a service delivery perspective, the pandemic gave us a crash course in crisis management as we led our services and supported our colleagues through the most difficult times.

It has been well documented that the morale of NHS staff who have worked under sustained pressure throughout the pandemic has been affected, and the strain of COVID-19-related fatigue is seeping into hospitals across the country as the long road to recovery continues amid uncertainties. Our hospital is no exception to this rule.

BMEC has always been a tight-knit community, providing specialist tertiary level care in the West Midlands as well as a vibrant center for education and training in ophthalmology services. Team spirit was high, with close interactions between departments and multidisciplinary teams. Seventeen months after the start of the pandemic, with the constant wearing of masks and social distancing, as well as the conversion of almost all educational programs to online webinars, the dynamics of our hospital have visibly changed.

The professional boundaries between ophthalmologists, optometrists, orthoptists and other allied health professionals have become less relevant, and colleagues continue to demonstrate tremendous camaraderie and support.

On the one hand, the professional boundaries between ophthalmologists, optometrists, orthoptists and other allied health professionals have become less relevant, and colleagues continue to demonstrate tremendous camaraderie and support. In contrast, departments are becoming more and more insular as the emphasis is placed on eliminating backlogs and there is less time for interaction between departments. We are optimistic that BMEC’s ​​old sense of tight-knit community from the pre-COVID-19 era will return.

On the patient side, the recovery of our services continues to accelerate and the demand for specialized ophthalmic services continues to grow. Committed teams and good planning keep our current recovery plans for optometry, orthoptics and visual function reasonably on track.

COVID-19 pathway improvement programs have been launched with NHS England / Improvement, focusing resources on a small number of specialties in order to streamline outpatient services in the post-COVID-19 era. The new programs incorporate work done by key organizations that have contributed to the National Eye Care Recovery and Transformation Program, including the Local Optics Committee Support Unit, College of Optometrists, Royal College of Ophthalmologists, The Society British and Irish Orthoptics, the RNIB, as well as the national Getting It Right First Time program and others.

Key principles of the Eye Care Services Restoration Program include: optimizing the use of the primary care optometric workforce; referral filtering; risk stratification and clinical prioritization of patients; large-scale use of digital tools (connectivity, virtual and video consultations); and monitor and manage low-risk patients in the community through primary care optometry and diagnostic treatment centers. In order to address the backlog in ophthalmology, work is underway to establish high volume cataract treatment centers as well as high volume, low complexity diagnostic centers.

Manage delays in the field and return training

There is a growing body of evidence-based literature highlighting the impact of COVID-19 on various disciplines and subspecialties within ophthalmology departments. The need for virtual and video consultations has been accepted as the norm to reduce the number of patient visits to hospitals. Virtual consultations are invaluable in specialties such as low vision services. However, they are of limited value in fitting complex contact lenses or vitreoretinal clinics where a physical examination is required.

Our Trust is already outsourcing some ophthalmic services, with a focus on those with the longest wait times: glaucoma and the medical retina. The safety of these two services will depend on the quality and reliability of the diagnostic tests. Robust audit and governance processes are essential to ensure the reliability of tests performed in high-volume diagnostic centers.

Virtual consultations followed by a letter to the patient and their GP do not give patients as much opportunity to voice their concerns or ask questions. Telephone consultations after virtual overhaul are a better option, but they take longer and are therefore less favored in newly designed routes.

In our first article in the series with OT, we explained that pediatric patients tend to be afraid of uniformed staff.

We are now noticing that children of all age groups, including newborns and six-month-olds, seem to accept masks as the norm. The primary vision screening service was significantly affected by school closures for children other than those of key workers, and then by the inability of schools to provide access due to a potential spread of the disease. infection. Screening ceased in March 2020 and did not resume until the end of October 2020. This led to screening of children in the first year rather than at reception, that is to say at an older age. advanced. The delay in detection and treatment may have a negative effect on the visual result. In order to “catch up” and manage the backlog, orthoptic staff had to be relocated from other departments to support screening. References would normally be fairly consistent throughout the school year. The impact of increased tracing capacity resulted in an increase in the number of referrals in a short period of time.

Large-scale research trials involving optometrists, orthoptists and other members of multidisciplinary teams are resuming. Some of our research is based on the impact of COVID-19 by comparing patients presenting to our emergency department with neurogenic eye motility defects before and since the first wave of the COVID-19 pandemic.

The optometry internships for independent prescribers are expected to resume from October 2021, and the orthoptic interns have already returned for on-site training. In the service of the visual function, support for the training of scientific trainee practitioners is now back to pre-COVID-19 levels and we are fully supporting our medical teams in the training of junior doctors.

As a manager, we continually try to protect our team members from long days and weekends which has benefited staff morale after such a difficult year.

Make every contact count

Patients who have been under the long-term hospital eye service often present varying accounts of the information they have heard in the news or on social media relating to COVID-19 when they present themselves to their patients. appointment. As professionals, this provides us with opportunities to reinforce the importance of vaccination and how they should remain aware of the risks posed by COVID-19. We also remind them that they should continue to follow existing rules and infection control and prevention tips.

As a manager, we continually try to protect our team members from long days and weekends, which has boosted staff morale after such a difficult year. For small specialist services such as visual function, it would be difficult to expand into evenings and weekends, especially alongside sick leave and annual leave.

As demand is expected to increase, low-band banking staff can be employed to cover more basic skills, freeing up experienced staff to perform complex electrophysiology and ophthalmic imaging work.

As HoS, our greatest asset is our people. An essential part of the COVID-19 recovery process at a tertiary center is not only to consider the length of our waiting lists and offer solutions using existing staff, but also to recognize that the the well-being of our colleagues must remain a top priority. priority as we learn to live with various forms of viruses.

About the authors

Dr Waheeda Illahi is Consultant Optometrist and Head of Optometric Services, Rosie Auld CBE is Head of Orthoptic Services, Dr Emma Berrow is Consultant in Ophthalmic Electrophysiology and Head of Visual Function, and Dr Peter Good is Consultant Neurophysiologist at Birmingham & Midland Eye Center.

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