In late March 2020 NHS Scotland launched the video appointments system Near Me in all hospital and GP services. Amidst the Covid19 crisis this offered the NHS Fife Orthoptic Service an exciting and innovative new way to stay connected to our patients. Initially we used the technology to create a link with on call doctors working in Covid red zones. Using an ipad, they could dial into the virtual orthoptic waiting room and receive assistance from an orthoptist to asses and diagnose emergency motility disorders without any exposure risk to our team and without any loss of clinical care for the patient. We also used iPad’s to link up with OT colleagues in stroke rehab wards and Dr’s performing Hospital at Home visits to assess patients eye movements, offer advice and answer questions regarding recovery.
Next we started to offer video appointments to our review adult patients and non emergency new referrals, including patients who were shielding at home. This proved to be a steep learning curve both for our patients and staff. Over a few weeks we identified common problems and in June we produced our Orthoptic Near Me Assessment SOP. This includes
- Near me Orthoptic assessment SOP document
- Near me patient clinical pathway
- Near me Orthoptic assessment patient guide
- Patient symptom self assessment leaflet
All new referral patients are invited to an initial hospital appointment where safe to do so. This involves a local COVID19 risk assessment. Following a diagnosis, all eligible patients are then moved on to a near me follow up. Any patient deemed at risk from a hospital environment or identified as shielding is discussed with the medical team and may be seen as a new patient via video appointment if appropriate.
Patients are given a symptom self assessment information leaflet which explains how to assess their symptoms once a week using a fixed target and gives them a list of questions we will ask at each appointment. We issue a Near Me patient guide giving practical advice on locating the camera on the device and making sure the device is charged. It also asks the patient to use a phone where possible – we have found a phone allows the patient to easily hold the camera close to their eyes with one hand and cover their eyes with the other hand as required. This can be difficult with larger devices such as a tablet or a laptop.
We have a clinic room identified as our Near Me suite which features a dual screen set up allowing for one screen to be used for the video link and the other for accessing patient records. The room provides a neutral, uncluttered background and is confidential. The clinical SOP document helps the orthoptist to set up and perform a meaningful virtual assessment and includes simple instructions which allows the patient to perform a near and distance cover test and basic motility assessment.
Patients are offered face to face appointments where a clinical need is identified and following a COVID 19 risk assessment. This includes any significant clinical changes or for prism assessments with patients needing to drive, return to work or at a falls risk.
Through the use of this SOP we have been able to diagnose a 4th, 6th and superior 3rd nerve palsy, monitor the recovery of an INO, monitor the progress of a CI patient undertaking convergence exercises and continue to offer assurances to our long term but stable motility patients. Of our adult patients cancelled due to COVID19, 68.5% have now been transferred onto Near Me follow up.
We are in the process of gathering patient feedback and hope to publish a poster of our findings. Initial feedback is positive; patients are delighted to be given the opportunity of an appointment, find the technology easy to use and prefer the “face to face” of video over telephone discussions.
We are very happy to share more details with anyone who would find it helpful, please contact me at l.wilson14@nhs.net
Written by Laura Wilson
BIOS Member
