Sir,

Thank you for forwarding the comments of Mr Shankar (published in Eye Vol 16, 2002, 108). It is important to note that reducing the number of hospital visits does not necessarily provide more effective use of time and resources. The ‘one-stop’ patients spent a whole day at the hospital as opposed to two half-days for clinic/pre-assessment and then subsequently surgery. They still require the appropriate amount of ophthalmic and medical work-up and counselling which in the case of our system was done by a senior house officer who spent a morning dedicated to the assessment of eight to ten ‘one-stop’ patients. So, although there is an obvious patient-oriented benefit in reducing the number of visits, the absolute workload for hospital staff is probably unchanged.

Regarding those patients not prepared for same-day surgery despite receiving appropriate correspondence, Mr Shankar has misinterpreted our data. Of the 34 ‘one-stop’ patients not undergoing surgery on the same day, three (9%) fell into this category. This represents only 1.6% of the total number of ‘one-stop’ patients.

With respect to poor theatre utilisation, as stated in the article, this was overcome to some extent latterly by including non-‘one-stop’ patients who are warned that their operation may be performed that day. When patients attend for an operation on their first visit to an eye unit unexpected findings will always arise, and although improving the quality of referrals by optometrists and general practitioners may reduce this, surprises will inevitably still occur which detract from efficient use of theatre time in a ‘one-stop’ setting.

The authors feel that the best way to ensure that theatre lists are filled is to be able to screen for potential problems at a prior visit and at our unit this currently combines outpatient consultation with preoperative assessment and (usually) dating for surgery.