Don't drop the patient: teamwork for cataract surgery

The purpose of a team is to work together towards a common goal. On an athletics track, relay race teams run with a baton that is passed from one team member to another, without breaking the pace. If the baton is dropped, the team is disqualified. The journey of the baton is a good analogy for the journey of someone who is visually impaired from cataract. Everyone has to work together within the health system to ensure that the patient is not ‘dropped’. In other words, the eye team must ensure that an informed patient, who is relaxed and mentally prepared for the next level of treatment, gets to a surgical centre and back home again. The patient's journey begins when cataract is detected and the patient is informed about the possibility of treatment. This is done at the community level by health workers – such as primary health care workers and community health workers – who then refer the patient to an ophthalmic clinician for assessment and/ or surgery. This stage of the journey has to be managed with sensitivity and reassurance for blind or vision-impaired patients, as they are likely to be afraid of surgery. There is also a return journey: a cataract patient must come back to the community for follow-up and postoperative care, including detection of complications and referral back to the surgical centre if needed. This ‘return loop’ is important, both for the postoperative management of the patient and for the process of assessing outcomes (for quality control and auditing, and feedback to the surgical team). The patient's journey is completed only when the patient has been followed up and is satisfied with the services and the outcome. If not, then any issues must be addressed or resolved and constructive and helpful feedback should be given to the appropriate team members.