"Referral journey for AMD to Eye Infirmary Plymouth"

A journey through Plymouth Royal Eye Infirmary for treatment.

My 88 yr old mother M, who otherwise was in very good health, has just attended for the first of 3 injections for wet AMD and we wanted to share the good and not so good parts of the journey so far and to make suggestions for improvement.

The worst part was the delay in the referral. The longest delay was because when M attended Boots opticians in November she was told she had AMD and nothing could be done. So when her sight in that eye started to get worse a couple of months later she thought there was nothing worth doing.

Only when she went back in June to Boots did the opticians say that what was dry was now wet AMD and she should be referred urgently. That 'urgent' referral took 2 weeks to get through to the referral management centre. We are not sure why and whether the delay was slow from the pharmacist or the GP.

However, Derriford hospital acted quite quickly; M was seen in a week and first treated, one week later.

So to today's hospital appointment.

Derriford Royal Eye Hospital has a kiosk sign in procedure. This was quite good except that it was not clear how to get the bar code on the referral letter read and it took several attempts before the kiosk read it. Other people less willing to persevere would have given up. Then the kiosk told us to wait but did not specify which part of the waiting area - we waited in the main area but only after we noticed that people were going down the corridor to other areas did we ask at the reception to find we were waiting in the wrong place. The kiosk should have been more specific (a chance for some improvement).

A question: Why don't hospitals (and GPs) make more use of patient photos? While in the waiting area, the nurse was regularly going round shouting out patients' names trying to 'find them'. Many patients can't hear well and everyone else gets to hear your name. If they had a photo on the front of the case notes they could find and check your name when in front of the person she thinks it is (another suggestion).

M had to wait for about 30 mins to be 'consented' by a doctor, while the specialist nurse could have been doing the treatment. Was the specialist nurse's time wasted? How much does the hospital spend on getting doctors to 'do consent'? Surely there could be a better way of doing consent, eg by a standard video presentation, by the nurse, or by the specialist who referred her to have the treatment the week before? If a nurse is doing the treatment why can a nurse not 'do the consent'?

As it was, the consultant doing consent had a strong accent and spoke very quickly, so that although M was nodding and saying 'yes' at various points, actually she did not understand. We noted that not all staff introduced themselves either.

The consent was then 're-explained' by a nurse - who was very good, gave a clear explanation. Even so in this situation would it not have been useful to be able just to make an audio recording to take back home to listen to? The nurse introduced herself - thank you nurse April (and thank you Kate Granger)!

So the doctors consent process was a waste of time for us but more importantly for the doctor and cost for the hospital. Suggestion: do the consent by video on an iPad and then allow the nurse to answer any questions, and only if there is a question of which they are not sure ask the Dr.

M had an eye test with this nurse, first on computer then on chart. Why these two methods? During this people were popping in to drop off case notes, and the member of staff who was to do the operation came in at one point in their operating gear. Is the point of wearing special gear for a clean treatment area not to make sure it stays clean? So why are they wondering around outside?

All the staff were friendly and polite and we thank them for their professional attitudes but think there are some suggestions that might make it better and hopefully save the hospital some money:

1. Photos on medical records to make it easier for patients to be found (no more shouting please).

2. Consent done by video using a voice over of someone with nice clear voice - then let the nurse take the questions and redeploy the doctor to something more useful.

3. Let's encourage patients to keep a recording of what was said so they can go over it again when patients get home

4. For those staff who missed it - make sure they get the #mynameis message - it makes such a difference.

5. A little tweak to the (good) log in kiosk system to say where to go (more specifically)

The ones who do not come out of this so well? Boots, better information should have been given at the November appointment, and something is going wrong with the referral process - either from the chemists at Boots or at the GP surgery.

So the NHS part of this worked well and the private sector part not very well.... not that we can generalise from this.... but......