Richard Waters, Senior Clinical Photographer, Medical Illustration
Douglas Neil, Head of Medical Photography
Mr Gary Shuttleworth, Consultant Ophthalmologist, Singleton Hospital
Swansea Bay University Health board
The Challenge:
- POLs are regularly detected (10-30% in adults) in primary care and range from benign to life threatening
- Prompt clinical recognition and detection is key to preventing long term damage
- Specialist services may be overburdened by referring all pigmented lesions for opinion
- Anxious patient waits for ophthalmology (18- 24 month waiting list)
Aim:
- Proof of concept of referral pathway redesign for POLS
- Provide high quality images for more accurate triage and diagnosis
- Facilitate early detection and treatment of ophthalmic melanoma
- Effective use of MDT skill set
- Reduce waits and RTT for ophthalmology
Approach:
- Ophthalmology specialist grades and redirects suitable referrals to POLS clinic
- Colour fundus photography, optical coherence tomography (OCT) scans and ultrasound are performed
- Ophthalmology specialist reviews scans and determines if they need to see patient in clinic or whether they can be discharged
Outcomes / Benefits:
- Service ran successfully, over 70 patients referred and imaged
- Reduced time and touch points for ophthalmology
- Reduced ophthalmology waiting list and RTT
- Patient focussed service with reduced patient time and patient touch points
- Referrals seen more quickly through Medical Illustrations
- Rapid triage reduces the risk of delayed assessments
- Service fits with the remit of ophthalmic photographers who are equipped with the knowledge, experience and skill set required for producing high quality diagnostically meaningful images.
What Next:
- Full POLS audit due to be completed
- Further test the service on a wider cohort of patients and lesion types
- Extend the model to different levels of service provision, e.g., vascular ulcers
- Support other health boards across Wales to adopt
