Built-in efficiencies ensure quality surgeries in high-volume practices

October 1, 2008

Practices can increase their efficiency by performing surgery in only one location, having multiple operating rooms (ORs) and an efficient preoperative area available, using anesthesia blocks preoperatively instead of topical anesthesia in the OR, choosing a safe and reliable phaco technique that minimizes surgical time, and hiring well-trained staff members.

Key Points

Iselin, NJ-Maintaining consistently high volumes of quality cataract surgeries on a daily basis is no small feat. One expert recognized as one of the top eye surgeons in the New York area, however, successfully has managed to answer the pressure.

Douglas K. Grayson, MD, FACS, medical director and chief of glaucoma and cataract surgery at Omni Eye Services, Iselin, NJ, and his team are responsible for numerous cataract surgeries each day, thanks to some strategies he has developed to save time and steps. The practice is able to manage numerous cases in the operating room (OR) for two reasons, he said.

"It can hurt your efficiency," he said. "It is not necessary, but most surgeons use this. In cases where you can't communicate well with the patient and you choose the topical route, you'll end up spending more time fighting with the patient than doing surgery. There is a big advantage of doing anesthesia blocks before the patient gets to the OR. It is simply not effective to do it in the OR."

At Omni Eye Services, two anesthesiologists begin their work in the preoperative area and then escort patients into the room. Appropriate anesthesia support is "critical," Dr. Grayson said.

Regarding use of products such as implant lenses, Dr. Grayson said he believes in using the best available, if possible. "Some surgeons will use lesser lens[es] to make more profit. But we're in business to try to help people see better," he said.

'Super coordinators'

Dr. Grayson also advised ophthalmologists to have at least one "super coordinator" within a practice. In Dr. Grayson's case, that person is a registered nurse; his practice actually has two such coordinators because of the volume of cases. Such a coordinator can help ensure that every patient gets the correct implant lens, among other tasks.

When considering hiring for this position, Dr. Grayson suggested asking the following:

Having a coordinator enables the ophthalmologist to review clinical cases ahead of time. Dr. Grayson said he has two RNs with him at all times. The reason for two?

"We can do 75 to 80 surgical cases in a day with three rooms," he says.

Practices managing 25 to 30 cases per day only will need one person, according to Dr. Grayson. Having one or more coordinators enables the surgeon to focus on the surgery and not other extraneous matters.

One of the ultimate goals in the entire surgical process is to try to make patients feel as comfortable as possible while providing individualized care-and to do both safely and efficiently.

"Therefore, we need somebody on staff and in the room at all times to make sure things go smoothly. Our super-coordinators are like wedding coordinators; they need to know what's going on during every aspect of the day," he said.

Many surgeons still prefer to operate with three ORs and no coordinator, Dr. Grayson said. "It's much more chaotic, and there's a good chance that the ophthalmologist is making mistakes," he added.

In cases involving a one-room OR, however, the experience would be much different, Dr. Grayson added. "You may be handling four cases an hour in one room. The time from when the patient goes out and the next one comes in allows the surgeon to check things out," he said. "To run efficiently in different rooms, however, where there is no time delay, you need to have someone you can trust."

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