Guidance on planning and delivering out of hours and emergency eye care

  • 16 Feb 2023
  • RCOphth

Most ophthalmology services are delivered in a planned way, but eye casualty attendances are estimated to be 20-30 per 1000 population each year. Accident and emergency departments will be able to triage and manage some conditions, but many complex sight-threatening emergencies will need to be managed by ophthalmologists with the wider multidisciplinary eye care team.

With many eye units facing workforce shortages and other capacity constraints, it is more important than ever to ensure the right processes are in place to provide an appropriate urgent and emergency care service.  Concerns that good practice was not being followed were raised by RCOphth Council members and the College is reminding members of available guidance for implementing this essential service and which can be used in collaboration with trust administration.

The RCOphth guidance on good practice for urgent and emergency secondary ophthalmic care, includes processes and principles for ensuring reliable administrative and clinical arrangements with the receiving unit (or units) so that referral/transfer is efficient, timely and maintains high standards of patient care.

Key points from this guidance include:

  • There should be access to protocols and guidelines for key high-risk emergency care (such as acute glaucoma, endophthalmitis, orbital haemorrhage, and acute central retinal artery occlusion etc), and triage guidelines for staff taking calls or initially assessing patients and ideally. These guidelines should be shared with primary care and general A&E colleagues.
  • Every eye unit and ophthalmic surgical provider must have a plan for emergencies and urgent care 24/7, and there must be a formal agreement in place with the receiving provider to accept cases if sent off site. This plan must cover:
    • Urgent and emergency advice and care for patients who have received care from the unit
    • Patients who come to or contact the hospital or the eye unit with an urgent problem
    • Urgent and emergency care of patients who are already in the hospital or unit for some other reason (e.g. an in-patient in a medical ward) who then develop an eye problem
    • Acutely unwell patients in eye settings
  • When a unit usually or routinely directs emergency patients elsewhere, it must have agreed reliable administrative and clinical arrangements with the receiving unit (or units) so that referral/transfer is efficient and timely. It is also important that reliable arrangements for on-going follow up and information sharing are made between the units so that, after an urgent problem, patients can, where suitable, be rapidly repatriated to their original or nearest unit rather than having to travel back to where they went for emergency treatment.
  • There must be supervision and availability of a consultant ophthalmologist or equivalent senior specialty doctor (SSD), such as a highly experienced and independently practicing associate specialist, who will carry ultimate clinical responsibility for emergency patients. A consultant or SSD must be available to provide advice at all times, including being available by telephone for advice out of normal working hours and being available to come into the hospital to see patients as required.

The full guidance document contains further detail on important aspects of planning emergency eye care in hospital eye units and other secondary care settings. This includes information on equipment and access to investigations, guidelines for nurse practitioners, optometrists and allied health professionals, operating on ophthalmic emergencies, audit and governance, and patient communication.

The RCOphth will write to the trust management on a member’s behalf.  Please get in contact with [email protected]