Diabetic retinopathy screening service from 1st Retinal Screen Ltd


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Patient Pathway & Screening Process > Patient Pathway Flow Diagram

Click your mouse on the images below for more information on each stage of the screening process


Finding patients	Inviting Patients	The Screening Procedure	Grading Images


Referral Management	Reporting	Quality Control	Patient Pathway Flow Diagram

The Patient Pathway Flow Diagram
The diagram below presents the patient pathway through the screening programme and where necessary into further examinations and hospital based treatment.

Patients with diabetes aged 12 and over (there is no upper age limit) will be invited to participate in an annual digital camera based retinal screening examination. This means that a patient with diabetes will be invited to attend a special screening clinic, where a number of photographs of the retina (back of the eye) will be taken and "graded" to ensure that any disease is identified early and if necessary treatment arranged. In 15% of patients it is not possible to take a good quality picture of the retina, perhaps due to the presence of a cataract or other media opacity (the back of the eye cannot be clearly seen using the digital camera). For these patients the pathway will lead to a Bio-Microscopy examination that can see through/around any cataracts or other media opacity.

For those requiring treatment, a referral will be made to the Ophthalmology Department. Early laser treatment is often effective in helping to stop or delay the development of diabetic retinopathy.

1. Load Patients with Diabetes & Those At Risk of Diabetes onto CDRIntell (from all sectors) CDRIntell is a web-based cross sector diabetes register which used sophisticated tools to find missing cases of diabetes. It loads and maintains the accuracy of data from General Practice, Hospital and Social Service systems.

2. General Practice reviews list of Those at Risk of Diabetes and confirms a diagnosis CDRIntell is a web-based cross sector diabetes register which used sophisticated tools to find missing cases of diabetes. It loads and maintains the accuracy of data from General Practice, Hospital and Social Service systems.CDRIntell finds on average 20-34% more cases of diabetes than presently diagnosed - helping to ensure these "undiagnosed diabetics" eye sight is also looked after.

3. General Practice reviews the Prior Notification Listings (PNL) & confirms for each Patient
with Diabetes their status in the DR Screening Programme General Practice are in control - they can specify whether to invite or not to invite patients and can change their status when ever they wish

4. Issue Invitation Letters (including Patient Information Leaflet) and Reminder letters if
necessary Invitation letters are issued invited the patient to contact the Booking Centre to chose a convenient date and time and location for their screening appointment. If no response is received reminder letters are issued.

5. Booking Centre receives Calls from Patients/Carers to Schedule Appointment/Refuse
Offer of Service Patients call to book an appointment, sometime we are informed that the patient has moved away, is deceased or does not wish to be screened, perhaps due to currently being under the care of an Ophthalmologist or due to mobility issues.The Patient's Practice is notified accordingly.

6. Issue Appointment Confirmation Letter, Patient Consent Form & Detail Information Leaflet Appointments are confirmed in writing and reminders issues nearer the time of the appointment.

7. Clinic Attendance & Screening (including obtaining Patient Consent) The Patient attends for screening, only a very small percentage of patients are not suitable for the procedure.

8. Grading the Images and Quality Control Up to three levels of grading take place, all non-negative images are graded by Ophthalmologists.

9. CDRIntell holds results, images & issues result letters to the Patients and their GP
Practice Once the Patient's Images have been Graded (including DR and Non DR Pathology) the images and results are stored against the longtutudial patient record and results letters are issued.

10. Referrals to Bio Microscopy or to an Ophthalmologists, if required Where the patient has a cataract or other media opacity preventing the retinal being checked, a referral for a further examination called Bio Microscopy will be made. A referral will be made in accordance with the DR Grading classification published by the NSC or where Non DR Pathology is present and warrants a referral as published by 1st Retinal Screen Ltd

11. Performance Reporting for all NSC Standards and all Diabetes NSF Standards CDRIntell is updated daily via interfaces with all relevant systems, for example, data on those under treatment is provided by the hospital sector. This enables Commissioners and General Practice to monitor the Retinal Screening Programme against the NSC Standards and more generally the care provided to patients with diabetes against the NSF Standards

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