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    Patients’ health jeopardized by failed ophthalmology follow-up

    Failure to follow-up after ophthalmology appointments can damage patients’ health, a new study suggests.

    Sixteen patients suffered serious incidents between July 2007 and November 2012 because they did not return for recommended appointments at the Moorfields Eye Hospital in London, according to investigators there.

    “In our view, national consideration should be given to create targets for reporting how well providers are managing follow-up patients,” reported A Davis and colleagues in the journal Eye.

    The problem is not limited to Moorfields. In 2009, the UK National Patient Safety Agency (NPSA) reported that 44 people with glaucoma experienced some harm as a result of delayed follow-up appointments from June 2005 to May 2009, including 13 patients who went blind.

    In response to the concerns of the NPSA, Moorfields analysed the records of patients lost to follow-up over 5 years.

    The researchers looked at the records of patients for whom no outcome was reported following an appointment. They identified 145,234 episodes as lost to follow-up. Most were within general ophthalmology and support services, such as optometry and orthoptics, and were judged to be low-risk.

    They deemed the highest risk cases to be glaucoma, which made up 3.6% of the cases, and retinal cases, which made up 10.7%.

    Next, they compared activity rates of subspecialty areas with rates of patients lost to follow-up. They found general ophthalmology, optometry, support services, and orthoptics had more unknown outcomes than expected. Glaucoma, medical retina, and external disease had lower rates than expected.

    The investigators found 79,562 (54.8%) of the cases were for patients who had died. Senior clinical staff reviewed the electronic patient records and paper notes, and discharged another 50,519 (34.8%) with notes to the patients and their general practitioners.

    They determined 15,153 (10.4%) required clinical review, and made appointments for 12,316 (8.5%).

    The hospital staff could not close 2,837 (1.95%) of patient episodes, and were continuing to address them at the time the authors submitted their article.

    Of these, 682 were episodes with appointments linked with support services. These patients remained under review in an ophthalmic subspecialty but were discharged from the support service.

    Another 1146 were accident and emergency patients. The notes for these were offsite and were gradually being reviewed as they became available. A review of a sample set of 50 showed no clinical harm.

    Another 246 patients were in the external disease service, so paper notes were also offsite and not initially available. The investigators could not find any clinical information either electronically or on paper. They wrote to the patients’ general practitioners for information, and offered future appointments to the patients. 

    Reasons for lack of follow-up

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