NHS England - Transformation Directorate

Supporting nurse-led triage with a clinical decision support tool in the paediatric ophthalmology A&E

Moorfields Eye Hospital use a clinical reasoning triage platform to help nurses, paramedics, physician associates and other frontline clinicians assess patients.

Situation

The eye casualty department were seeing a considerable increase in demand, even before the COVID-19 pandemic. Attendances have increased 7.9% year on year. This made it difficult to provide enough capacity to match the demand.

The growing use of allied health professionals such as nurse practitioners and optometrists is helping to address this increased demand. However, many of them have limited training in emergency ophthalmology conditions and their care pathways.

Aspiration

The hospital wanted to allow the nursing team to take on these additional clinical responsibilities with greater autonomy, efficiency and safety in the paediatric A&E.

Solution and impact

The hospital used the Dem Dx Ophthalmology triage platform to support nurse-led triage in the paediatric A&E at Richard Desmond Children's Eye Centre. The service offers appointments on weekdays from 9am to 4pm.

When the patients arrive, the nurses use Dem Dx Ophthalmology to guide them through the history taking. This ensures all relevant questions are answered.

It highlights specific actions to take such as investigations and initial management or onward referral. For example, nurses will apply dilating drops before the ophthalmologist appointment or they will refer the patient to orthoptic. This avoids having to wait to see a doctor.

It also provides a list of possible differential diagnoses to consider with transparent clinical reasoning. This allows training while using the platform.

The platform also enables care delivery to be consistent, even with less experienced staff, as the whole team follow the same action points.

Functionality

Dem Dx Ophthalmology:

  • is a web platform
  • has a comprehensive history and has completed over 2,000 diagnoses
  • highlights warning signs and symptoms
  • suggests tests, investigations and onward referrals at the most appropriate step on the pathway
  • is customisable by the service's protocols
  • uses clear and intuitive clinical algorithms that are easy to explain
  • is available for desktop, tablet or phone
  • can be linked to electronic medical records

The team can save the pathway with actions and notes. This allows case documentation and handover to be seamless.

Capabilities

The platform brings together clinical knowledge from leading ophthalmologists with artificial intelligence. It follows the natural clinical reasoning and supports staff with:

  • clinical assessments when patients present symptoms
  • incidence-ranked list of differential diagnoses

Scope

The platform supports:

  • nurses to make clinical decisions when they need to triage acute ophthalmology conditions, making A&E services more efficient
  • structured descriptions of the patient's condition and actions taken for handovers

Key figures and quotes

  • 68% increase in nurse-led investigations.
  • 300% increase of diagnosis determined by the nursing team.
  • 18% reduction in doctor’s investigations, freeing up time to concentrate on more challenging cases.
  • 30% reduction in patient 'time to assessment' and 9% reduction in time spent in A&E.

“The DemDx Ophthalmology Triage Platform has provided us with ongoing clinical support and training enabling the nursing team to take on additional clinical responsibilities with greater autonomy, efficiency and confidence.”

Lauren Blackshaw, Paediatric A&E Charge Nurse Moorfields Eye Hospital

Key contact

Lauren Blackshaw, lead paediatric nurse, Moorfields Eye Hospital

lblackshaw@nhs.net

Dr Mariane Melo, Chief Medical Officer

mariane@demdx.com