Mapping Greener HealthcareMapping Greener Healthcare

Project Description

Background: Personal health records, where patients (and/or carers) maintain information about the patient’s health and well-being, are increasingly used in the context of care for chronic diseases and are theorised to improve patient outcomes. Patient adoption of personal health records (in this case, a Glaucoma Passport) is complex and poses unique challenges in an ophthalmic setting.

Approach: The team chose to investigate patient adoption of the Glaucoma passport by looking into proportion of adoption and factors influence adoption.

Intended Benefits

Patient outcomes: Further research is needed to determine the impact on patient outcomes.

Environmental, Financial, Social: The assessment identified the cultural and societal barriers to adoption and utilisation of the passport across demographics, specifically with patients of African-Caribbean descent least likely to adopt and utilise the passport. The results of the assessment guides staff to consider the varying needs and characteristics of patient groups when developing and implementing the passport to maximise patient utility. Further investigation is needed on the environmental and financial benefits.

Potential Barriers

Challenges to the project and passport adoption by patient:

• Forgetfulness on part of the patient and/or carer
• Poor visual acuity
• Lack of confidence in its utility in their care from patient/carer perspective
• Disparities in uptake of passport by ethnicity

Key Aspects of the Project

This project focused on the barriers to adoption of personal health records in an ophthalmic setting and the disparities in adoption.

Project Description

Background: Patient held records (or personal health records) are way for patients (and/or carers) to maintain information about the patients’ health and wellness. They are becoming more commonly used in healthcare, particularly for management of chronic diseases like glaucoma. However, the evidence to support their use is unclear.

Approach: The team recruited 56 patients and administered questionnaires about glaucoma knowledge before and after a glaucoma logbook (i.e. patient held records) was integrated into care. The data was analysed to assess knowledge about glaucoma.

Intended Benefits

Patient outcomes: Benefits to patient outcomes are undetermined at the moment, but should be monitored to determine effect of logbook adoption.

Environmental, Financial, Social: The glaucoma logbook had a positive impact on patient knowledge, showing a significant increase in the knowledge score (Z = -4.176, p < 0.001). This could improve patient satisfaction through empowering patients to engage in self-care and management of their health and well-being. The environmental and financial impacts of using a glaucoma logbook are largely unknown, but possibilities include reducing printing out records and streamlining care with an integrated logbook.

Potential Barriers

Challenges to implementing this system:

• Initial adjustment and integration of logbook usage
• Cultural and societal barriers to adoption of logbook across all demographics

Key Aspects of the Project

The team suggested that further research should be done on a larger sample size to see if the effects are consistent. Also, investigation into effects on long-term structural and functional outcomes should be done. This project focuses on the patient experience by improving patient knowledge through use of a glaucoma logbook.

Project Description

Background: The service utilisation of Emergency Eye Care (EEC) in the UK is unknown from the provision to number of patients using the services. It would be useful to service provision to know the allocation of resources such as staff type and workload burdens.

Approach: Through a Freedom of Information (FOI) request, the project worked to understand the provision of EEC service in 108 hospitals within 101 trusts. Of these, 77% provide a booked service within working hours. On average, nearly 3 staff persons are allocated to EEC (ranging from 1 to 11). Staff can consist of consultants, nurse practitioners, and optometrists. About 31.7 patients are seen per day per EEC unit with about 3107 total in the UK. Almost 40% use electronic patient records, mostly through Medisoft.

Intended Benefits

Patient outcomes: By providing an overview of EEC provision, this can help inform efforts to improve patient outcomes related to access and provision of services.

Environmental, Financial, Social: Like patient outcomes, these findings help lay the groundwork for further investigation on how to reduce negative environmental, financial, and social impacts while increasing positive ones in EEC service.

Key Aspects of the Project

This project provided a foray into understanding EEC provision in the UK.

Project Description

Background: In 2017, the International Agency for the Prevention of Blindness (IAPB) inaugurated an Environmental Sustainability Working Group (ESWG) and workshop. The group recognises that healthcare greenhouse gas emissions have a significant impact on the climate and aims to develop a Triple Bottom Line Sustainability Programme to reduce the impact of eye healthcare on environmental impact and support resilience to climate change.

Approach: During the ESWG workshop in Kathmandu in 2017, a qualitative approach was taken to process proposals for sustainability, using thematic coding. They identified priorities for increasing capacity and sustainable community cataract programmes. The proposals produced 9 categories: procurement of lower carbon consumables/reusables; patient pathway changes, greener energy, buildings, care closer to home, policies, human resource, waste, and transport.

Intended Benefits

Patient outcomes: Patient outcomes should be monitored to see if changes produce an effect.

Environmental, Financial, Social: The changes to the process of eye healthcare proposed are assumed to have environmental, financial, and social impacts. The proposals have identified ways to reduce, reuse, and recycle consumables/reusables as well as reduce transport to services and use renewable energy. The financial and social impacts are unknown at the moment.

Key Aspects of the Project

This project engaged eye healthcare providers and leaders to gain a better understanding of planned approaches to sustainable care.

Project Description

Background: Paediatric surgery cancellations can be unavoidable; however, the cancellations can have significant emotional and socio-economic impacts on the patients, carers, and families.

Approach: This project explored cancellations of elective paediatric surgeries. There were 219 surgeries, of which 81% were elective and 19% were urgent. Of these cases, 43% were cancelled at least once. Among the cancelled ones, there was an average of 2.41 cancellations per patient and 21% had avoidable causes. Also, adequate notice was given in only 18% of cancellations.

Intended Benefits

Patient outcomes: This project can inform how to provide adequate theatre time for urgent operations and ensure patient needs are addressed appropriately.

Environmental, Financial, Social: The findings of this investigation support the use of a traffic light system to reduce repeat cancellations, improving patient experience and minimised penalties for hospitals due to cancellations. If patients were given adequate notice or experienced less cancellations, patients and carers could save time on hospital visits and travel in addition to avoiding the emotional toll of cancellations.

Key Aspects of the Project

Cancellations of surgeries can have major financial and social impacts on patient experience along with carers and families. By investigating the cancellation of paediatric surgeries, the patient experience can be improved, and resources can be saved.