In this case study, Horizon Fellowship Fellow Richard LeeConsultant Ophthalmic Surgeon and Director of Ophthalmology at Chelsea and Westminster Hospital NHS Foundation Trust, explains how he is using Ufonia’s artificial intelligence (AI) innovation ‘Dora’ to optimise and standardise his existing ophthalmic pathway.
Project summary
Ophthalmology is a priority of the High Volume Low Complexity (HVLC) programme, which is the responsibility of NHS England. Get It Right the First Time (GIRFT) initiative. Part of the HVLC includes the optimization and standardization of the pre- and post-operative pathway.
The current cataract pathway at Chelsea and Westminster Hospital is plagued by long waiting times and limited capacity, requiring patients to attend a mandatory in-person pre-operative appointment before being placed on the waiting list for surgery on their first eye. The ‘no-show’ (NST) rate for these pre-operative clinics ranges from 30-50%, leading to wasted clinical capacity. Of those who do attend, only around 70% consent to surgery, which is far from the GIRFT target of 85%.
Additionally, although preoperative reminder text messages are sent to patients, they are sent only twice: the day a patient is listed for surgery and the day before surgery to remind patients to complete their lateral flow tests. Current DNA rates for these surgical lists are approximately 5%. Preoperative patient-reported outcome measures (PROMs) are also not currently collected, although they are the audit standard for the National Ophthalmology Database (NOD).
After surgery, although the risks of complications and adverse events related to cataract surgery are very low (<5%), all postoperative patients are required to attend a face-to-face appointment four weeks later. After consultation, patients are listed for their second eye operation or discharged to the community.
UfoniaDora’s artificial intelligence (AI) innovation has identified efficiencies in the ophthalmology space. Dora is an AI-powered autonomous voice clinical assistant that uses automation to deliver high-volume, low-complexity clinical conversations. It can call patients and conduct a routine clinical conversation instead of having to be done by healthcare staff. Patients are also not required to use or learn any specific technology, but interact with Dora as if it were a regular phone call, increasing clinical capacity, reducing costs, and providing a more reliable, convenient, and consistent patient experience.
Since implementing Dora, we have seen a significant reduction in no-shows for pre-op assessments, post-op follow-ups and surgeries. This has resulted in cost savings. When patients say they do not want surgery, we can schedule them with other patients, which helps reduce the waiting list.
Emma Newland
Deputy Head of Ophthalmology Department
Context of the project
We were fortunate to be approached by CW Innovation to pilot Ufonia as part of the Cataract Pathway at Chelsea and Westminster Hospital. The pilot would not have been possible without the support of our CW Innovation Business Partner, Christina Sothinathan, who liaised between all the key stakeholders: the eye clinic staff and consultants, the Trust and Ufonia. We had to go through several stages that took a lot of time and effort, with multiple meetings and paperwork to ensure we ran the pilot safely. Even after the pilot had started, we learned a lot during the process which we managed as a team and in an Agile process to ensure we improved and optimised the pilot and its outcomes as it progressed.
Since using Dora, we have received excellent feedback from patients about how easy Dora phone calls are. We have found that appointments are less stressful as clinics are now running on time as we receive screening information from Dora in advance of patients’ appointments.
Thida Kyaing
Advanced Nurse Practitioner in Ophthalmology
Impact/Results
Over the past six months, we have made over a thousand calls using Dora.
At the pre-operative assessment stage, we achieved a 65% call success rate, exceeding our initial goal of 60%. Additionally, we achieved a 91% concordance rate between Dora and our clinic staff, exceeding our goal of 90%.
Other notable successes include:
- 81% of patients responded to the preoperative reminder call, which is well above our goal of 50%.
- Same-day cancellation rates have dropped significantly to just one patient in six months, compared to four patients per month prior to Dora implementation, exceeding our goal of two patients.
- Less than 2.5% of patients at postoperative follow-up experienced an unexpected change in management, well below our target of 10%.
- 63% of completed calls passed the Dora assessment, exceeding our goal of 50%.
Patients (who are not native English speakers and have an accent) have praised Dora for her ease of understanding compared to normal human appointments. This means we can spend more time with patients who have more complex needs, making our work more satisfying and less stressful.
Natalia Wojtowicz
Advanced Nurse Practitioner in Ophthalmology
Our work on the pilot also earned us recognition as a finalist in the HSJ Digital Awards 2024 for the Driving Change through AI and Automation Award.
Next steps
We have demonstrated significant improvements in efficiency and reliability by integrating Dora into our existing cataract pathway. We now aim to formally adopt Dora to free up capacity for our team, allowing us to focus on patients who require in-person consultations. We also plan to advocate for the regional implementation of Dora in the North West London cataract pathway, with the ultimate aim of promoting its use nationally.
Applications for the second cohort of the Horizon Scholarship are now open until Sunday, August 4, 2024. To apply, fill out the application form Or Email horizon@cwplus.org.uk for more information.
For more information about the Horizon Scholarship, Visit the CW+ website or consult our Innovation Directory to browse the full list of Fellows.
Ufonia is a graduate company of the DigitalHealth.London Accelerator program.
THE DigitalHealth.London Accelerator The programme is funded by the UK Government through the UK Shared Prosperity Fund (UKSPF). It is delivered by the Health Innovation Network (HIN) South London in partnership with the Office of Life Sciences, CW+, Medicity, NHS England, the Mayor of London and the Levelling Up Fund.
For more information, please visit https://www.gov.uk/government/publications/uk-
Shared Prosperity Fund prospectus.
