You can tell a lot from a cataract surgeon's body language. And his sighs. Well, at least Larry Cox can. As a surgical coordinator for Vantage Outsourcing, Mr. Cox has a unique perspective on what makes eye cases go well. He and others who work at cataract outsourcing companies across the country make sure that thousands of surgeries in hundreds of facilities run smoothly each week. They've seen what works and what doesn't — and they're about to share some of that insider information with you.

So when a surgeon sits back in his chair, shrugs his shoulders and sighs, Mr. Cox knows just what to do next: reach for the vitrectomy kit, Miochol-E and suture. There's the first piece of advice: Read and react in the OR. Anticipate the doctor's next move and beat him to it.

"I like to stay at least one step in front of the doctor and the staff," says Mr. Cox. "If a doctor needs to do a vitrectomy, my job is to have that ready as soon as he makes the comment or I read his movements. As soon as I know that something is up, I get out the vitrectomy kit. Hopefully you never need it, but if we do, I have [the supplies] out before I'm even asked."

You should never have to make a run to the supply room to get needed supplies, says Mr. Cox. Keep everything you could need in the room. If you don't use an item, he says, you can return it to the supply room at day's end. Mr. Cox assembles a plastic box with everything he could ever need for a cataract case. "This way it's all right there within reach — I just pop it open rather than walking out of the room or even across the room," he says.

Think of anticipating a surgeon's needs this way, says Mr. Cox. If you stay one step ahead of your surgeon, if you have the needed instrument in your hand before the surgeon needs it, that's fewer times that he has to look up from the scope to make eye contact with you when he requests something.

Extra pair of hands
Besides transporting and setting up all of the equipment and supplies that a surgery center or hospital needs to perform cataracts, outsourcing companies provide facilities with something equally important: another pair of experienced hands in the OR, hands that are skilled, strong and willing to help out wherever and however needed, be it assisting the surgeon, transporting patients or turning rooms over. Mopping the floor, taking out the trash, stripping the bed — no job is too small, says Addison Owen, a surgical coordinator for Vantage.

"I can free up a scrub to go help the circulator get patients in and out of a room," says Mr. Owen. "Because I'm cleaning the room between cases and getting product ready for the next case, the scrubs can focus their energies on turning the room over."

Ronda Chambers, RN, the nurse manager of Physician Surgery Center in Rolla, Mo., welcomes a tech (she calls hers an "instrument of efficiency") from an outsourcing company to her center every first and third Friday of the month. From 7:30 a.m. until about 1 p.m., an ophthalmologist bouncing from room to room handles 25 to 45 cataract cases.

"The tech brings everything — all the packs, BSS, equipment," says Ms. Chambers. "I don't keep anything in house except for lenses on consignment."

It was the outsourced tech's idea to use 2 rooms in tandem on cataract days. "I didn't realize that we could get that many cases done in such a short amount of time," says Ms. Chambers. "Our tech helps with patient care and physician care. He makes sure the surgeon has everything he needs to do the procedure as it should be done. There's a sense of security with him in the room because he's so well-versed."

Pearls from the experts
Don't overlook the benefits you'll find in the person who drives and delivers these things to your door. Here are pearls you can apply to your cataract cases.

• Tape the spot. Use colored tape to mark the spots on the OR floor where the wheels of the bed should be positioned, says Mr. Owen. This way, the surgeon doesn't have to waste time readjusting the scope for every patient. Once you get the bed positioned for the first case of the day, put little tape strips on the floor to serve as markers.
• Wheel patients into the room. For Mr. Owen, the most efficient way to transport patients from pre-op to the OR and back to post-op is to keep an eye bed in each OR and then wheel patients to and fro. Many times the patient can get himself out of the wheelchair and onto the bed. Let the bed stay in the room, where you can quickly strip it and make it up with fresh linens. Mr. Owen says stretcher chairs are also a time-saving way to transport patients.
• Invest in eye beds. You'll spend an extra 2 or 3 minutes positioning the patient for cataract surgery if you don't wheel him in on an eye bed, which of course is equipped with a head extension. "If you've got an eye bed, you're not taking that extra time to position that patient," says surgical coordinator Bruce McNary.
• Don't let your docs stand idle. The cardinal sin of cataract surgery is making your surgeon wait for the next patient. Be sure you're moving patients from pre-op to the OR quickly. "If you know your doctor is doing 10-minute cases, don't wait until he's done 1 patient to go get the next," says Mr. Owen. "Get the next patient into the OR." He puts it another way: You can't make your doctors go any faster, but you can make your facility go faster.
• Appoint a cataract team. Keeping the same 3 or 4 nurses on the same cataract team leads to consistency, says Mr. McNary. "The places that I go to that do it right keep that same team together in the same room throughout the day and things go smoothly," says Mr. McNary.
• Make it fun. Eye cases aren't the most exciting. That doesn't mean you can't make the day enjoyable, says Mr. McNary. Post a sheet of paper of all the day's cases on an OR wall where all can see it. Set a goal for what time in the day you want to be done. As you cross off each patient's name, you'll see how many more cases you have before you reach your goal. "It's fun to have the finish line in sight," says Mr. McNary.
• Post a procedure list on the wall. Think of this as posting a start-to-finish instruction manual on the wall, a step-by-step set of typed directions for how a particular surgeon does his cases, says Mr. McNary. "Cataract surgery is so much about consistency: doing the same thing over and over," he says. "If the doctor is putting viscoelastic in the eye, then you know to have the lens injection system in hand. It really does help. You never know when you're going to get somebody in the room who's never worked with a particular doctor."