Providing Safe and Effective Intravitreal injections - Episode 5

Advice for Opening a High-volume Intravitreal Injection Clinic

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Experienced ophthalmologists provide advice for opening up high-volume intravitreal injection clinics.

Nadia K. Waheed, MD, MPH: David, if you were advising someone who is just setting up a new high-volume practice, what advice would you give them about increasing efficiency and safety? I know you’ve discussed some of the safety part, but how about also increasing the efficiency of doing intravitreal injections in a safe manner?

David M. Brown, MD: I think the main thing is staff training. You want to make sure that you know what you’re doing, but you’ve got to make sure that the staff both on the informed consent side concerning giving them preoperative, whatever cocktail you have, whether you’re subconjunctival injection or topical lidocaine or gel, you want to make sure they’re doing it the way you want it done and that they can answer the questions appropriately for the patient to feel comfortable. If you do all the prep yourself, you’re never going to have a high-volume clinic.

Nadia K. Waheed, MD, MPH: Great staff is part of the secret sauce.

David M. Brown, MD: Staff and teaching, and sort of a mentorship where you have, before anybody sets up injections, where they’re tutored a lot by senior staff so that nobody is getting thrown to the wolves and I always have them mark the eye with a sticker. I always look at the OCT [optical coherence tomography test] and the chart before. I’m always concerned about giving an inappropriate injection to the wrong eye. The staff need to know that it’s incredibly important to do those double checks each time. It’s even more important with our hearing-impaired older patients, I might have three Mrs Smiths, but you’ve got to make sure it’s the right Mrs Smith or even Mrs Schwartz, who thinks she hears Mrs Smith, because I’ve certainly had patients about to get ready for an injection and it’s a new patient. And that’s why you do all the double checks. The patients are hard of hearing, and you want to make sure that all those safety precautions, similar to what you do in the OR [operating room] on same-side safety, are followed.

Nadia K. Waheed, MD, MPH: And we generally always do a timeout in clinic that would involve both the patient, as well as if I have a tech helping you, or a nurse helping, you involve the nurse. But you’re right that many of these patients are hearing impaired. Often, just the patient, yourself, and the consent might not be enough, and you may want to pull up the OCT on the screen, which we always have pulled up with our patients to confirm that it’s the right eye.

David M. Brown, MD: Most of my patients, I know, I walk in the room and I’ve seen them for 10, 15 years. “How are your kids?” And at wherever Lehigh University or wherever they are, but especially patients when you’re in clinics where you’re seeing at your partner’s clinics or whatever, I always have the chart open in the room; an electronic chart. Any question I ask them, their date of birth.

Nadia K. Waheed, MD, MPH: No, that sounds great. I think this is a unique phenomenon. We see many of our patients every month or every couple of months. I find that I know them and their grandkids, and their families better than their primary care physician knows them. And I can generally tell that there’s something going on faster than the primary care can.

Transcript Edited for Clarity