Here are six tips to improve the efficiency of the cataract surgery OR.
No. 1. Single-specialty facility. In terms of overall efficiency, safety, and specialized service, I believe that there are many advantages to a single-specialty (ophthalmology- only) facility. Patients love the fact that all of the staff—not just the surgeon—specialize in ophthalmic surgery. The surgeons, of course, have the opportunity to develop a very close-knit working relationship with a small group of surgical nurses and technicians. By focusing only on ophthalmology, the administrative staff has a unique understanding of the needs of these patients and surgeons.
No. 2. Standardized protocols. With 15 surgeons actively operating at our ophthalmic ambulatory surgical center, we have tried to standardize protocols when it is feasible. This extends from preoperative orders to the way IOLs are handled and then crosschecked prior to surgery. Our surgeons attempt to use the same monofocal IOL model and the same basic ophthalmic viscosurgical device for their routine cases.
No. 3. Two ORs. If the option is available, alternating between two ORs increases efficiency for the surgeon and the staff. With this setup, there is never the situation where two patients must simultaneously occupy either the corridor or the recovery area. Running instrument trays through the autoclaves is easier to manage as well. We can schedule right and left eye cases in separate rooms, decreasing the need to move the equipment and foot pedals.
No. 4. A top-of-the-line operating microscope. In my opinion, this is not the place to try to reduce capital costs. Having a “best-in-class” microscope gives surgeons that extra edge of an optimal surgical view for complicated and difficult cases. Several features improve efficiency by allowing the surgeon to adjust the microscope’s position and illumination without relying on nursing personnel. These features include having a magnetic clutch to lock and unlock the microscope, foot pedal control of illumination levels, and a surgeon-controlled knob to dynamically change the proportions of oblique and coaxial illumination (as with the Opmi Lumera 700 [Carl Zeiss Meditec, Inc., Dublin, CA]).
No. 5. Specialized ophthalmic surgical gurneys. Although they were significantly more expensive, we purchased ours from UFSK-International OSYS GmbH (Regensburg, German). The gurneys were designed specifically for ophthalmic surgeons and have a wide range of motorized adjustment options. The patient climbs on and off the gurney when it is in a “chair” configuration. Preset memory buttons position the patient for preoperative preparation and for eye surgery. The additional positioning options improve patients’ comfort, and the head section is especially constructed to allow even tall surgeons to sit comfortably at the temporal side. UFSK also allowed me to develop a customized detachable pillow section that better supports my hands. These gurneys are also easier for the staff to transport, and they avoid the need for the patient to move again after he or she has arrived in the preoperative area.
No. 6. Electronic medical records. Despite mixed reviews as to whether electronic medical records improve office efficiency, we use a stand-alone system (Experior Healthcare Systems, Fort Wayne, IN) at our ambulatory surgical center. The ability to use templates and checklists and have immediate digital “signing and filing” saves significant time for the nurses, anesthesiologists, and surgeons, and the electronic medical records system is integrated with our claims, coding, and billing system.
David F. Chang, MD, is a clinical professor at the University of California, San Francisco, and is in private practice in Los Altos, California. He acknowledged no financial interest in the products or companies mentioned herein. Dr. Chang may be reached at (650) 948-9123; firstname.lastname@example.org.