Maria Scott, MD, founder, medical director, cataract and refractive surgeon at Chesapeake Eye Care and Laser Center in Annapolis, MD, is always looking for ways to improve efficiencies within her practice to maintain their hallmark of superior patient care. “With the increasing number of patients needing cataract surgery, it is critical to be as efficient as possible,” says Dr. Scott.
According to the National Eye Institute, by 2050, the number of people in the United States with a cataract is expected to double from 24.4 million to about 50 million. “This exponential growth, driven by the aging baby boomer population, is compounded by several other factors that impact cataract surgery and the patient’s experience, which in turn affects how we manage our practice,” says Dr. Scott.
Modern-day life brings with it three areas that play an important role in the management of cataract patient care.
Patient education and marketing
The first area is an increase in patients’ knowledge about cataracts and the surgical procedure. The growth of information technology is reshaping health care. With patients’ access to information across multiple platforms, more older patients, as well as their caregivers, are researching medical conditions and treatments prior to their office visits.
This access to information impacts several patient touchpoints from the website to call center, front desk staff, technicians, surgical coordinators, and surgery center. Marketing efforts and staff all need to be coordinated. Ensuring that the team is well educated lends to efficiency by enabling everyone to answer patient questions throughout the entire visit. If accurate information is provided and the patient’s concerns are addressed throughout the process, it better prepares the patient and helps keep the appointment on time.
“More of our patients come in for their cataract evaluations with varying information and expectations,” says Carolyn Schmidt, COT, clinical research lead technician. “It’s up to us to educate them about the options, pros and cons and how the different intraocular lens (IOL) options relate to their specific vision needs, lifestyle and health. Managing patients’ expectations is a huge part of what we do.”
At Chesapeake Eye Care, cataract evaluations are scheduled as one comprehensive appointment, which includes a complete eye exam, pre-testing, and measurements necessary for cataract surgery. This makes for a longer appointment (usually three hours), but the intention is to have patients come in for one appointment only. Also, the length of the appointment is conveyed to the patient upon scheduling with the call center, which is another opportunity to set patient expectations. By gathering all the data at one visit, the patient can schedule surgery if recommended at that time.
“Mindful of our patients’ time, we have found this to be the most effective approach to our cataract evaluations,” Dr. Scott says.
Addressing changing lifestyles
The second key area that affects cataract care is the changing lifestyles of the population. Patients are living longer, more active, healthy lives. The growth of mobile devices is also playing a role in cataract counseling and desired vision. Going from mobile phones to tablets to other daily activities is playing as much of a role as type of work and personal hobbies in the decision.
These factors not only impact the volume of patients, but also the individual visual needs of each patient. With the expansive selection of IOLs, the practice now has the opportunity to address these lifestyle changes; however, identifying the best option for the patient is critical to patient satisfaction and a great outcome.
“During the exam, we review our Lifestyle Questionnaire, which each patient is given ahead of time,” Ms. Schmidt says. “This document drives our exam because it helps us identify the patients’ chief complaints, how their vision is affecting their lifestyles and their goals after surgery. It is really important for us to understand our patients’ specific visual needs to ensure a successful outcome. One of my patients could not read the chart plotter on his boat, and his primary goal post-surgery was to have great vision at that distance.”
As the team realized how critical this counseling role was becoming to their cataract evaluations, they conducted several time studies to assess patient flow. The result was a redesigned team approach to the cataract evaluation. They added more technicians to help with the testing and flow, to give ample time to counseling each patient. This tremendously increased efficiency, as the surgeon was well informed of the patient’s specific vision needs prior to meeting the patient. “Our whole goal when we see patients is to position them for success and maximize the surgeon’s time with the patient,” Ms. Schmidt says.
By having all the measurements, exam results, and knowledge about which point a patient wants to see clearly or if there is a specific visual need, the surgeon is better able to determine the most appropriate lens for that patient.
To further enhance the patient experience, specific scribes are matched with each surgeon. This enables the scribe to anticipate the surgeon’s requests and the surgeon to focus on the patient instead of the computer during the exam.
“Now, instead of Dr. Scott asking for a patient’s OCT images, I know when she will want to review them and they’re already waiting for her,” says Paige Stratton, OSC, scribe. To ensure that the process was seamless and consistent for each exam, even if a team member was absent, Chesapeake Eye Care created a manual that outlined each step of the entire process.
An additional tool created to maximize patients’ time and experience is a personalized video featuring the surgeon, who reviews cataract surgery and its benefits and risks. “The video, which our scribes play for the patient, ensures that each patient receives the exact same information, every time,” Dr. Scott says. “It also gives me the opportunity to spend more time with the patients discussing their specific needs, as opposed to going into great detail about the procedure.”
One other area that the doctors and staff saw a need to improve was the surgical scheduling department. As lens choices grew, it became cumbersome to have numerous sheets of paper discussing the lenses, insurance, and pricing. More importantly, it was very confusing for the patients to follow. The result was a comprehensive, streamlined document that outlined the different lens options, pricing and insurance. “This makes our scheduling process so much easier, as we are able to circle the recommended lens choice for patients to reference when they leave the appointment,” says Christi Hahn, surgical coordinator.
Additionally, the team developed a simple drop schedule that includes pre-operative and post-operative drops, displaying clearly an image of the actual drop container, as well as dates and dosage. A separate schedule is created specifically for diabetics, who require a different regimen. Lastly, the team crafted a calendar for patients listing out the actual dates of all pre-op and post-op visits, as well as any additional appointments needed (health and physical, retina) for one and/or both eyes.
“This calendar is invaluable to patients as they can easily forget any one of their appointments,” Ms. Hahn says. “It also helps us be more efficient, since we can send the patients’ primary care doctors the necessary information to schedule their pre-surgical physical the day the patient schedules surgery.”
By tweaking their system in these different ways, Chesapeake Eye Care’s team has increased their efficiency, maintained a good flow mindful of patients’ time, and delivered better results to happy patients.
Advancements in technology
The advent of laser cataract surgery, astigmatism-correcting devices, and lens options has impacted surgical centers across the board; however, these technologies have impacted flow and efficiency as well. Chesapeake Eye Care, dedicated to running the most efficient surgery center possible, focused on shaving seconds off that added up to hours and caused back up and long wait times. The surgery team revamped several areas of their center to allow for an extremely well-oiled, coordinated team.
“One of the most important aspects is ‘preparedness,’” says Jennifer Knopp, surgery center manager. “Our team speaks with each patient prior to surgery to ensure that he or she knows what to expect and answer any outstanding questions. It is also imperative that my team be prepared prior to our start time. We all arrive one hour earlier than the first appointment to review the cases and any special circumstances. Every staff member is well trained and cross trained to ensure an efficient flow throughout the day. This type of training prepares us for any unforeseen staff emergencies, allowing team members to fill in if necessary.”
Another area that changed was with dilating drops. Initially, patients were given the dilating drops to use at home on the day of surgery; however, patient compliance was becoming an issue as several patients would arrive for surgery without having placed the dilating drops in their eyes. This resulted in delayed surgery start times and disrupted patient flow. To alleviate the problem, every patient is now dilated at the time of arrival, which significantly improved the flow and efficiency of the surgery center.
Finally, the team’s dynamics changed in two ways. They revamped the flow in the surgery suites — time studies revealed longer time requirements for the femtosecond laser.
“To reduce the time, our surgeons now use the femtosecond laser back-to-back on several patients and then return for the individual phacoemulsifications,” Ms. Knopp says. “The result of this one change was huge, reducing our surgery time from 25 minutes to 15 minutes.”
The second way that they dramatically increased efficiencies to the flow was by designating one staff member to be the conductor or “maestro.” “Similar to the maestro of a well-coordinated orchestra, having someone in this role to be a step ahead of the surgeon, directing her exactly where to go, anticipating her needs, and managing any unforeseen events, was critical for patient safety, surgical flow, and patient satisfaction,” Ms. Knopp says. “This also alleviated stress points and time constraints for the surgeon and nurse staff.”
In keeping an eye on efficient patient care, “Increasing efficiencies throughout the practice results in better patient care and a successful team of employees,” Dr. Scott says. “Paramount to everything we do on both the clinic side and surgery center is providing outstanding patient care. We strive daily to give each patient the best experience possible from the exam to surgical outcome.” OP