The patient had her first cataract removed at a major medical center in Philadelphia. "She said it felt as if she'd gone in for open heart surgery," says Claire Welliver, RN, the director of nursing at the Main Line Surgery Center in Bala Cynwyd, Pa. The patient's experience when her surgeon removed her second cataract at a warm and friendly ASC? "She said it was like visiting a spa to get her hair done," say Ms. Welliver.

There's no doubt that the more you do to make cataract patients feel relaxed and welcome, the more good things they'll have to say about the care you provide. Oftentimes, it's the little things that matter most. "We hold patients' hands as they're heading back for surgery and throughout the entire procedure," says Ms. Welliver. "We tell them to give a little squeeze if they have any issues and that we'll be right there to help. They absolutely love that sense of connection."

What else can you do to ensure your patients have a pleasant stay?

1. Make a connection

Cataracts are 60% of the caseload at the Delray Beach (Fla.) Surgery Center. "They're our bread-and-butter procedures, so we make sure patients feel valued," says Carol Cappella, RN, MSN, CNOR, the facility's clinical director.

Those efforts begin as soon as cases are scheduled when members of Ms. Cappella's staff call patients to invite them to register for surgery through the center's online portal, which lets them fill out electronic forms at their convenience. Staff members follow up with patients in the days before surgery to briefly review the information patients have submitted and to answer questions they might have about their procedure.

They also use that opportunity to make connections and establish relationships with patients that make them feel informed and comfortable about what will happen on the day of surgery.

"Older patients who undergo cataract surgery often enjoy talking on the phone and they're usually excited to meet the staff member who they spoke to when they arrive for surgery," says Ms. Cappella. "Don't ignore the importance of establishing that personal bond as soon as possible."

2. Ensure their comfort

Sedative tablets are available that deliver midazolam, ketamine and ondansetron through the mucosa of the tongue. They work very well to relax and sedate patients without subjecting them to an IV start, but Charles B. Slonim, MD, suggests using them on a case-by-case basis. "Some patients don't want to be aware of anything when their eyes are getting worked on. For them, IV sedation is probably best," says Dr. Slonim, a clinical associate professor of ophthalmology at the University of South Florida Eye Institute in Tampa, Fla.

A significant part of efforts to calm patients at the Delay Beach Surgery Center is aimed at increasing perioperative efficiencies so they don't get anxious as they wait for surgery to begin.

"We ask patients to arrive an hour before surgery, so their eyes have plenty of time to dilate," says Ms. Cappella. "They're also always being talked to or touched, so they never feel ignored or like they're sitting in one spot for too long with nothing happening."

Letting patients remain in street clothes during surgery is a facility-specific policy, but doing so adds to their comfort throughout their stay. "It makes the whole experience feel less invasive," says Ms. Cappella.

3. Be clear about cost

Ms. Welliver's facility offers femtosecond laser cataract surgery and her surgeons implant premium IOLs, which contribute to improved refractive outcomes. Patients expect to pay out of pocket for improved post-op vision, but keeping them informed about the exact amount they'll owe on the day of surgery eliminates discussing an anxiety-inducing topic during the already anxious minutes before surgery.

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"We call every patient to let them know exactly how much they owe," says Ms. Welliver. "They also sign forms beforehand that detail the out-of-pocket costs, so there are no misunderstandings on the day of surgery."

Keeping patients in the dark about cataract surgery's pass-through costs could have clinical implications. For example, a patient with a significant astigmatism might show up for surgery and refuse to pay for implantation of a toric IOL, which would have greatly improved their vision, because they assumed their insurance would pay for the premium lens.

"They need to know if spending out of pocket for improved visual outcomes is worth the added expense or a waste of money," says Christopher Kuntz, MD, a cataract surgeon in Seattle, Wash. "In some cases, patients are leaving a significant amount of happiness on the table."

4. Set realistic expectations

Make sure patients understand that eyes need time to heal after surgery, suggests Dr. Slonim. "They might see perfectly immediately, but shouldn't feel discouraged if that doesn't happen," he says. "Some patients get upset because they think the surgery didn't go well."

Dr. Slonim would know, because he was a disgruntled patient. As he sat in post-op on the morning of his own cataract surgery, distant images appeared blurry, but his name on his ID wristband was perfectly clear. He thought he was myopic, that he had received the wrong lens implant power. His vision acuity remained less than optimal into the afternoon and he grew frustrated with the surgeon, who he felt had not delivered on his as-advertised outcome: "off-the-table 20/20."

"Patients who see perfectly immediately after surgery are ahead of the game," says Dr. Slonim.

Surgeons who operate at Ms. Cappella's center make sure patients know from the moment they schedule their procedures that their vision could be blurry for a few days post-op. The surgeons also reinforce that point to the patients and their loved ones on the day of surgery. "They tell them to stay off the computer and not to watch TV — to relax and take it easy," says Ms. Cappella. "Educating patients about what they'll experience after surgery is incredibly important."

5. Remember the patient's perspective

Making each patient feel like they're the only one you're operating on that day can be challenging when cases last no more than 15 minutes, points out Dr. Slonim. "Still," he says, "patients should never feel like they're a cog in the assembly line."

It's easy to lose sight of the fact that patients are coming in for a singular experience. "I encourage every member of the surgical team to be mindful of what the patients are experiencing," says Dr. Kuntz, "and to constantly look at cataract surgery from their point of view."

Dr. Kuntz is sure to share reassuring words with a patient as soon as her case ends and is quick to set her expectations for the next planned procedure. "Patients are still lightly sedated, so they're in a suggestive state," he says. "I let them know how well the procedure went, how great of an experience they're having — and how much I'm looking forward to removing the cataract from their other eye in a couple weeks." OSM