Hospital waiting time targets causing avoidable blindness
Hospital waiting time targets causing avoidable blindness; ophthalmologists call for urgent Government review
The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) has renewed calls for an urgent government review of waiting time targets that are putting people’s vision at risk. The call comes ahead of the publication of the Health Quality and Safety Commission’s (HQSC’s) annual report in November. The report is expected to highlight the negative impact on patients of delayed follow-up appointments and to specifically highlight the speciality of ophthalmology as an area of high risk.
“Limited resources mean that meeting waiting time targets for initial specialist appointments is often at the expense of follow-up appointments. This leads to increased health risks for patients with chronic eye conditions,” explained Dr Shenton Chew, an Auckland-based ophthalmologist and RANZCO Fellow. “In many medical specialities, it makes sense to prioritise initial appointments as patients can be treated with less need for ongoing specialist care. In ophthalmology, many of the conditions we treat are chronic, often with few obvious warning signs, and patients are at risk of losing their vision without regular and timely specialist check-ups.”
With the HQSC’s report expected to highlight the high risk associated with ophthalmology patients not getting timely check-ups, RANZCO is calling for the Government to take action and has proposed a three-part solution. The proposal calls for assessment and adjustment of waiting time targets so that prioritisation is based on medical need, investment in training for nurses and optometrists to work alongside ophthalmologists and, ultimately, appropriate funding of ophthalmology services to ensure that supply is sufficient to meet demand.
“We need targets that allow ophthalmologists and other health care professionals to make decisions based on the needs of the patient. A one-size-fits-all approach simply isn’t working. Patients are going blind in cases where this should have been avoided,” said Dr Chew.
While the Ministry of Health’s targets aim to reduce the waiting times for diagnosis and treatment by medical specialists, patients who have been diagnosed with eye disease and are in need of regular check-ups, are having their appointments cancelled or delayed to make way for new patients to meet targets.
For KB, a 23-year-old who was diagnosed with glaucoma, the lack of a timely check-up meant that his worsening condition wasn’t identified and he was left blind in one eye, with urgent surgery required to save the sight in his other eye. Despite his ophthalmologist saying that he needed regular check-ups and despite chasing up with the hospital repeatedly to get an appointment, KB was left waiting months longer than he should have for a follow-up appointment. Eventually, he managed to get an appointment, but by this stage it was too late and he was told he was permanently blind in one eye – a situation that could have been entirely avoided if he had seen his ophthalmologist sooner.
“All of my doctors told me how important regular
check-ups are. The fact that the hospital ignored this, even
when I chased for an appointment, shows how messed up their
priorities are. I am just lucky that I still have sight in
my left eye,” said KB. (See below for full case
RANZCO has seen figures that show that District Health Boards (DHBs) throughout New Zealand have a significant backlog of eye patients who are overdue for their follow-up appointments, with one DHB having as many as 7000 patients waiting.
In addition, a report, Social and economic cost of macular degeneration in New Zealand, due to be launched by Macular Degeneration New Zealand in the coming days shows that the cost of blindness due to macular degeneration, which is preventable with the right treatment, is around $216.6 million a year. This vastly outweighs the cost of treatment to prevent people going blind in the first place.
“Allowing chronic eye conditions to advance unchecked places a significant burden on the health service, with more complex, time consuming and expensive treatments required,” explains RANZCO President Dr Brad Horsburgh. “Studies show that, while the cost of treating chronic eye conditions and having regular check-ups to maintain eye health is minimal, the economic impact of treating and supporting a person who has lost their vision is substantial. The Government could make cost savings in the long run by preventing blindness now.”
Note: Ophthalmology is the branch of medicine concerned with the diagnosis and management of disorders of the eye and visual system.
KB – case study
With a family history of glaucoma, KB always made sure to have regular eye exams to check his sight and his general eye health. At his eye exam in 2013, KB’s optometrist spotted signs of glaucoma and referred KB to the hospital for diagnosis and treatment by an ophthalmologist. The ophthalmologist confirmed the glaucoma diagnosis and prescribed an eye drop treatment. He scheduled regular check-ups to monitor and manage KB’s condition.
Initially, KB had a check-up every three months and, when his condition seemed fairly stable, he was moved on to check-ups every six months. The first six-monthly check-up went well and KB was told to come in again in six months’ time.
Six months later, when KB was due to for his check-up, no notification of an appointment appeared. Understanding the need for regular check-ups, KB contacted the hospital and requested an appointment. He was told that there were no appointments currently available, to be patient and that he would be contacted when an appointment was available.
Several months later, KB found himself suffering from painful headaches emanating from his right eye. After a while, having started accidentally walking into doors and still suffering from severe headaches, KB realised that there was a problem with his sight. Once again he contacted the hospital and he was finally given an appointment.
When he saw the ophthalmologist, almost six months later than he was supposed to have a check-up, KB was devastated to learn that his condition had worsened, damaging the optic nerve and leaving him permanently blind in his right eye, and his left eye in danger of following suit.
KB was immediately sent for surgery at another hospital. He had urgent glaucoma surgery (Trabeculectomy) to save the sight in his better (left) eye. KB then had surgery by Dr Casey Ung on his blind right eye to implant a Molteno tube to relieve the pressure on his eye, which was felt to be causing the headaches. Finally, KB had a second surgery on his right eye to insert a second Molteno tube and further relieve the pressure which was still quite raised.
Since his surgeries, KB has had regular check-ups with Dr Ung. Initially these were daily check-ups, which then moved on to weekly, then three-weekly and, now, monthly check-ups. His most recent check-up shows that the pressure in his right eye has been significantly reduced, although not entirely corrected.
Luckily, KB has managed to retain most of the sight in his left eye, but he is fully and permanently blind in his right eye.
“All of my doctors told me how important regular check-ups are,” explained KB. “The fact that the hospital ignored this, even when I chased for an appointment, shows how messed up their priorities are. I am just lucky that I still have sight in my left eye, because I am now permanently blind in my right eye. It’s so annoying to know that it was entirely avoidable if only I had been given the appointment when I was supposed to.”