Kerry O’Hara, Associate Director, Transformation & Service Redesign at NHS Gloucestershire discusses a pilot scheme to bring Eye Care Liaison Officers into care of the elderly (COTE) wards.

With 43% of patients in this environment experiencing eye problems, she explains the role of bedside eye care in reducing hospital readmissions.

Bedside eye care

Eye Care Liaison Officers (ECLOs) act as a vital bridge between medical and nursing staff in health clinics and social care teams. The ECLO service is provided by the Royal National Institute of Blind People (RNIB).

Kerry explained: “By supporting the wellbeing of patients in eye clinics, ECLOs help prevent avoidable sight loss.

“One of their key roles is to offer emotional help and practical guidance to those who have been diagnosed with an eye condition.

“They do this by talking through treatments and medication as well as helping service users to access other support such as benefits, provision of aids and adaptations at the earliest opportunity.”

NHS Gloucestershire has a well-established Eye Health Clinical Programme Group (CPG), and in 2022 a new pilot scheme began to bring ECLO services into COTE wards.

“We know that 43% of patients on COTE wards have unmet eye needs,” said Kerry.

“This can often cause problems when it comes to admission or delays in discharge from hospital. It was noted that these unmet eye needs would have a significant impact on the ability of patients to live normal and independent daily lives.

“Since June 2022, a service offering bedside screening and eye support of the elderly in hospitals has been successful in reducing hospital readmissions, and admissions which potentially could have been avoided through better eye health diagnosis and treatment.”

A joined-up approach

The ECLO team link in closely with community, acute hospital and local authority teams. They are the bridge between hospital wards and the ophthalmology team ensuring consistent lines of communication and support about service users who have eye health care needs.

“ECLOs also have access to Medisoft, which is the system that Gloucestershire Hospitals NHS Foundation Trust’s Ophthalmology team uses to store patients’ hospital eye health records,” explained Kerry.

“Joint access to the system and patient eye health records aids in the sharing of relevant information about patients between services to ensure consistency of care.

“This means that any patients who are admitted with existing eye support needs or treatment plans can be sure these are continued during their hospital stay.”

Bedside screening

The aim of the ECLO is to reduce hospital readmission due to sight issues that may cause falls or other accidents.

One of the main ways to do this is by performing a bedside sight screening. This allows ECLOs to inform other healthcare professionals about any known or unknown eyecare issues with patients in COTE wards.

Kerry said: “A bedside vision screening is undertaken jointly by ECLOs and trained ward staff such as occupational therapists.

“From this, the ECLO has the ability to identify those in need of support on the wards, provide valuable tools to assist their stay in hospital and ensure they are known to Ophthalmology if necessary.

“This service is particularly useful as due to the nature of emergency hospital admissions, many patients are admitted without their normal visual aids and adaptations.

“In our project, of patients tested at a bedside screening failed, meaning their eye needs were not being met and 28% of those tested required onward referral to Ophthalmology.

“Hospital optometry appointments are made available, with the aim of COTE patients being seen before they are discharged.

“This ensures that patients have spectacles, visual aids and adaptations for the inpatient stay.

“In the event that their discharge is before they are seen by the optometry team, further support can be given after discharge through home visits via ECLO referral or self-referral to clinic.” added Kerry.

A view from the ward

Nicola Beeston-Davis is an eye care liaison officer for Gloucestershire Hospitals NHS Foundation Trust. She has seen a positive growth in the scheme throughout her time working on COTE wards.

“Since joining the project in May 2022 it has grown in many ways, from simple but vital support on the wards for vulnerable elderly patients who as well as coping with an unfamiliar environment, and other comorbidities also have a visual impairment,” said Nicola.

“Emotional support has shown to be invaluable to many of the patients I have screened, having someone to talk to about their eye condition and experiences.

“Due to other health conditions the sight element can at times be overlooked and not given full consideration, even if they are known and receiving treatment from optometry teams.

Nicola added: “A recent example is a lady who had never accessed services. Due to my screening and referral to the eye care team she was diagnosed with dense cataracts and a macular hole.

“This was extremely important information to support her transition from hospital as she was not returning home but moving to a care home. This gave vital information to her family and the care home as otherwise they would have not known of the visual impairment she was experiencing.”

Rolling out ECLO support in Gloucestershire

Kerry has also seen great success in this work to date. “We have made contact with the community hospitals throughout Gloucestershire to promote and advocate the bedside vision screen on admission and referrals,” she said.

“By doing so, we hope to further bring down avoidable admissions, and ensure patients can be discharged as quickly as possible.”