Timely surgeon arrival affects procedure times

Anesthetics can quicken cataract discharge

Most of the 62 same-day surgery programs that participated in the 2002 and 2003 Cataract Extraction with Lens Implantation Study experienced a decrease of five minutes or more in at least one aspect of procedure time. The study was coordinated by the Wilmette, IL-based Accreditation Association for Ambulatory Health Care’s Institute for Quality Improvement.

One organization experienced a notable decrease of five minutes or more in three aspects of procedure times and reported an overall facility time decrease of almost 20 minutes.

One of the changes made between 2002 and 2003 at Balian Eye Center in Rochester, MI, occurred when the medical director reviewed his center’s data related to delay of first case.

"I discovered that the first case of the day was usually delayed five to seven minutes as a result of me being late when it was my patient," admits Mike Raphtis, MD.

This delay is not unusual, according to data included in the benchmark study: 31% of the cases included in the study were reported as being delayed five or more minutes, with the delay ranging from six minutes to 205 minutes. Reasons for the delays were previous cases running over time in 69% of the cases, a late-arriving surgeon in 22% of the cases, a late patient in 6% of the cases, and anesthesia-related in 3% of the cases, according to the report.

Although Raphtis would be at the center prior to the time of surgery, he might not start to scrub and get ready for the procedure until the scheduled time, he explains.

Now, he starts to prepare prior to the scheduled time so the procedure starts on time, he adds. This improvement contributed to an overall facility time, which is defined as the time the patient enters the facility to the time the patient is ready for discharge, of about 100 minutes. This is 28 minutes less than the median facility time of 128 minutes for all study participants.

Another organization with an average facility time about 75 minutes is Park Eye and SurgiCenter in Flint, MI. The same-day surgery program’s average turnover time of slightly more than 10 minutes is better than the overall median time of 13 minutes reported in the study for several reasons, says Fritz Bruening, MD, director of the program.

"We use two operating rooms for the surgeon and set up for left eyes in one room and right eyes in the other room," he explains. "This means that we don’t have to move equipment around to prepare for the next patient, and this saves time."

Turnover time in the study was defined as the time used to clean up after one procedure and set up for the next procedure.

Other median times reported in the study are:

• The median pre-procedure time, which is defined as the time the patient enters the facility to the time the patient is in the operating or procedure room, is 72 minutes.

• The median procedure time, which is defined as the procedure start time to the time the procedure has ended, is 14 minutes, with times ranging from four to 29 minutes.

• The median setup time, which is defined as the time patient’s supplies arrive in the operating room to the time the patient enters the room, is 10 minutes.

• The median cleanup time, which is defined as the time the patient leaves the room to the time the room is ready for the next patient’s supplies, is three minutes.

The benchmark study also looks at different aspects of the patient’s care such as dressings and anesthesia. Fifty percent of patients included in the study did not have an eye patch or other dressing, and surgeons did not use sutures in 93% of the cases. The type of anesthetic used was topical, alone or in combination with oral or intravenous medications, in 52% of the cases; peri- and/or retrobulbar in 41% of the cases; and a combination of topical and block in 7% of the cases.

The study also includes information on patient outcomes such as vision changes, unscheduled follow-up visits, and postoperative pain:

• Ninety-seven percent of patients reported a change in vision following surgery, with 99% of those patients reporting an improvement in vision.

• Ninety-eight percent of patients felt their pain was adequately controlled following discharge.

• Almost 10% of the patients had to contact their physician for an unscheduled follow-up for questions about eye patch, medications, and aftercare instructions, as well as vision problems and pain control.

• The percent of patients needing an unscheduled follow-up reported symptoms associated with infection, such as pain, bloodshot/red eye, or itchy eye, was 1.6%.

The information in the report has been helpful to the center, Raphtis says. "The entire staff review it and discusses it in our quality improvement meetings," he says. "This is a great way to review our performance in comparison to others and to find the best ways to improve patient care."

Resources

For information, contact:

E. Mike Raphtis, MD, Medical Director, Balian Eye Center, 432 W. University Road, Rochester, MI 48307. Phone: (248) 651-6122.

Fritz Bruening, MD, Park Eye and SurgiCenter, 5014 Villa Linde Parkway, Flint, MI 48532. Phone: (810) 733-5450.

The 2003 Cataract Extraction with Lens Implantation Study is $50 per report. To obtain a copy, contact:

Accreditation Association for Ambulatory Health Care, 3201 Old Glenview Road, Suite 300, Wilmette, IL 60091-2992. Phone: (847) 853-6060. Fax: (847) 853-9028. To order on-line, go to www.aaahciqi.org, choose "order" on the left navigational bar, then scroll down to 2003 Cataract Extraction with Lens Implantation Study.