Volume 185 - Issue 1
The efficacy of a nurse-led preoperative cataract assessment and postoperative care clinic
Authors: Hamish D R McKee and Glen A Gole
Med J Aust 2006; 185 (1): 49. || doi: 10.5694/j.1326-5377.2006.tb00453.x
Published online: 3 July 2006
Published online: 3 July 2006
To the Editor: We believe the study by Kirkwood et al,1 investigating the use of nurse-led perioperative cataract clinics, contains flaws, and their conclusions are premature.
The authors do not explain the reduction in elective surgery waiting times. Use of a nurse-led clinic should not affect surgical throughput, which is dictated by surgeon and theatre availability.
The rate of postoperative complications with cataract surgery is very low.2,3 An assessment of the concordance in management between the nurse practitioner and ophthalmologist would therefore only be possible if a large number of patients were compared, not just the 18 used in the study.
The authors do not justify the statements “a nurse practitioner might be more . . . experienced in managing patients with ophthalmic conditions” [than a junior registrar] and “the experienced nurse practitioner might be more efficient in use of consumables and investigations” by reference to their own clinic or the literature. In our opinion, a medical practitioner is best placed to understand and make these decisions.
In Queensland, registrars perform or observe most cataract operations done in public hospitals. It is important for their training to see these patients both before and after surgery,4 making the presence of a nurse practitioner unnecessary.
If the authors are interested in increasing the efficiency of the process, they could reduce unnecessary clinic visits, which is very relevant here in Australia given that patients may have to travel great distances for operations.
The two preoperative visits proposed in the authors’ model could be replaced by one. Standardised referral forms can be used for screening, and facilities can be put into place so that all necessary tests can be performed on the same visit for eligible patients. The 4-week visit can be eliminated if the patient’s dispensing optometrist is aware of the expected postoperative visual acuity and can readily refer back if there are any concerns.
Although the model outlined by Kirkwood et al has merits, the conclusions are misleading. Health care providers and governments must find ways to deliver high quality care during this period of workforce shortages. This should be achieved by increasing efficiency, while preserving doctor training opportunities, rather than through role substitution.
References
- Kirkwood BJ, Pesudovs K, Latimer P, Coster DJ. The efficacy of a nurse-led preoperative cataract assessment and postoperative care clinic. Med J Aust 2006; 184: 278-281.
- Kamalarajah S, Silvestri G, Sharma N, et al. Surveillance of endophthalmitis following cataract surgery in the UK. Eye 2004; 18: 580-587. 0_i1091788
- Muhtaseb M, Kalhoro A, Ionides A. A system for preoperative stratification of cataract patients according to risk of intraoperative complications: a prospective analysis of 1441 cases. Br J Ophthalmol 2004; 88: 1242-1246. 0_i1091790
- Ormonde SE. Ophthalmic microsurgical training: are we approaching a crisis point? Clin Experiment Ophthalmol 2005; 33: 453-454. 0_i1091793