Optimising Cataract Day Surgery: Patient-Reported Factors Affecting Punctuality For Staggered Appointments

In high-volume cataract surgical hubs, minor delays in patient flow can lead to significant inefficiencies in theatre utilisation, poor list throughput and suboptimal patient experience from high waiting times. This audit explores patient arrival patterns and patient-reported contributing factors for lateness in staggered cataract day surgery appointments. It also aims to provide recommendations to improve overall efficiency and patient satisfaction.

This audit was conducted at a cataract day surgery unit in Edgware Community Hospital which is a regional cataract surgery hub in the United Kingdom. This hub services patients across four hospital sites in North central London as part of a tertiary ophthalmology service. Currently, patients attending a cataract list are given staggered appointments. For example, morning appointment slots were given at 7:45, 7:45, 8:00, 8:30, 9:15, 9:30 and 10:00.

Data was collected from September to December 2023 involving a sample group of patients arriving for routine cataract day surgery at Edgware Community Hospital. Patients completed a questionnaire asking for their appointment time, arrival time, total journey time, reasons for late attendance, transportation mode, accompanying individual, difficulties reaching the hospital and lastly, their preferences for applying dilating drops prior to their appointment.

Of the 42 respondents, 21.4% experienced lateness with a mean delay of 20 minutes. Reasons for delay reported by patients included traffic (33.3%), navigation challenges (22.2%) and prolonged journeys (11.1%). Correlations indicated higher lateness in patients with longer journeys, using public transport, travelling alone, undergoing the first eye surgery and having earlier appointments. 33% of patients reported difficulties reaching the hospital due to traffic and difficulty in locating the day surgery unit. Lastly, 60% of patients were willing to apply dilating drops before the appointment.

The audit provides valuable insights into patient arrival patterns and reasons for lateness. It also explores patient-reported barriers to accessibility of a surgical high volume hub. Simple recommendations include improving patient communication preoperatively with information on how to locate the day surgery unit and scheduling patients with lower risk of lateness to earlier appointments. Another consideration is the use of pre-arrival dilating drops by patients to reduce waiting time. These adjustments have the potential to significantly improve efficiency and the overall patient experience within the day surgery unit.