Implementing Automated AI-driven Dora Phone Calls to Patients across the Cataract Surgery Pathway ​

In this case study, Horizon Fellowship Fellow Richard Lee, Consultant Ophthalmologist Surgeon and Service Director in Ophthalmology in Chelsea and Westminster Hospital NHS Foundation Trust, shares how he is using Ufonia’s artificial intelligence (AI) Innovation ‘Dora’ to optimise and standardise their existing ophthalmology pathway.

Project Summary

Ophthalmology is a priority in the High Volume Low Complexity (HVLC) Programme, which falls under NHS England’s Getting It Right First Time (GIRFT) initiative. Part of HVLC includes optimising and standardising the pre and post-operative pathway. 

The current cataract care pathway at Chelsea and Westminster Hospital faces long waiting times and limited capacity, requiring patients to attend a mandatory in-person pre-operative appointment before being placed on the surgery waiting list for their first eye. The ‘Did Not Attend’ (DNA) rate for these pre-operative clinics ranges from 30% to 50%, resulting in wasted clinical capacity. Among those who do attend, only about 70% consent to surgery, falling short of the 85% target set by the GIRFT initiative.

In addition, while pre-operative reminder texts are sent to patients, these are only sent twice: the day a patient is listed for surgery and the day before surgery to remind patients to do their lateral flow tests. Current DNA rates for these surgical lists stand at approximately 5%. Pre-operative Patient Reported Outcome Measures (PROMs) are also not currently collected, despite being the National Ophthalmology Database (NOD) standard for audit.

Post-surgery, though there are very low risks of complications and adverse outcomes from cataract surgery (<5%), all post-operative patients must attend an in-person appointment four weeks later. After consultation, patients are listed for their second eye surgery or discharged to the community.

Ufonia’s artificial intelligence (AI) innovation ‘Dora’ has identified efficiency savings to the ophthalmology pathway. Dora is an AI-enabled autonomous voice-based clinical assistant and uses automation to deliver high-volume, low-complexity clinical conversations. It can telephone patients and conduct a routine clinical conversation as an alternative to this needing to be done by healthcare staff. Patients are also not required to use or learn any specific technology, instead interacting with Dora as if it were a normal phone call – increasing clinical capacity, reducing costs and providing a more reliable, convenient and consistent patient experience.

Since implementing Dora, we’ve seen a huge reduction in non-attendance to pre-operative assessment clinics, post-op follow ups as well as surgery. This has resulted in cost savings. When patients state they do not want surgery, we can fill their appointments with other patients which helps to reduce the waiting list.

Emma Newland
Ophthalmology Assistant Service Manager

Project Background

We were fortunate to be asked by CW Innovation to pilot Ufonia as part of the cataract pathway at Chelsea and Westminster Hospital. The pilot study wouldn’t have been possible without the support of our CW Innovation Business Partner, Christina Sothinathan, who acted as the link between all key stakeholders: the eye clinic staff and consultants, the Trust and Ufonia. We had to go through several steps that took a lot of time and effort with multiple meetings and paperwork to ensure we conducted the pilot safely and securely. Even after the pilot commenced, we learnt a lot during the process that 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’ve had excellent feedback from patients about how easy the Dora phone calls are. We have found appointments less stressful as clinics now run on time as we receive screening information from Dora prior to the patients appointments.

Thida Kyaing
Ophthalmic Advanced Nurse Practitioner

Impact/Outcomes

Over the past six months, we have conducted over a thousand calls using Dora.

At the pre-operative assessment stage, we achieved a 65% call completion rate, surpassing our original target of 60%. Additionally, we reached a 91% agreement rate between Dora and our clinic staff, exceeding our goal of 90%.

Other notable successes include:

• 81% of patients completed the pre-surgery reminder call, well above our target of 50%.
• On-the-day cancellation rate has dropped significantly to just one patient in six months, compared to four patients per month before implementing Dora, surpassing our target of two patients.
• Less than 2.5% of patients at the post-operative check experienced an unexpected management change, well below our target of 10%.
• 63% of completed calls passed the Dora assessment, exceeding our target of 50%.

Patients [who don’t have] English [as] their first language and who have accents have complimented how Dora has understood them very easily compared to normal human appointments. It means we can spend longer with patients who have more complex needs making our jobs more satisfying and less stressful.

Natalia Wojtowicz
Ophthalmic Advanced Nurse Practitioner

Our work relating to the pilot has also resulted in us being honoured as finalists 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 with the integration of Dora into our current 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 across North West London’s cataract pathway, with the ultimate goal of promoting its use on a national scale.

Applications for Cohort Two of the Horizon Fellowship are now open until Sunday 4 August, 2024. To apply, complete the application form or email horizon@cwplus.org.uk for more information.

For more information on the Horizon Fellowship, visit the CW+ website or check out our Innovation Directory to browse through the full list of Fellows.

Ufonia is an alumnus company of the DigitalHealth.London Accelerator programme.

The DigitalHealth.London Accelerator programme is funded by the UK Government via 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.