Highly Efficient Cataract Surgery

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Put practices in place to make procedures smoother and easier for surgeons, staff and patients.


Most cataract surgeons can remove a cloudy natural lens and implant an IOL in less than 10 minutes, so high-volume ophthalmic facilities thrive by finding ways to fast-track patient care at the margins. Efficiency permeates every aspect of cataract surgery, from how quickly procedures are performed to how satisfied patients are with the surgical experience. Let’s look at several ways our team achieves excellent outcomes while working smarter and not harder to perform up to 24 cases in a day.

Versatile mobility. Stretcher chairs are near-essential pieces of equipment. Patients sidle into a chair in pre-op and remain on the same surface until they’re ready for discharge, a factor that adds to their comfort level and allows staff to move them through each phase of care as efficiently as possible. The chairs also eliminate the risks associated with lateral transfers for patients and staff.

Hooking patients up to vital signs monitors that remain attached to stretcher chairs eliminates the time-consuming process of removing and reattaching the leads several times at each phase of care. Using wrist clips instead of sticky pads to hook patients up to the monitors allows staff to make the connection more quickly and prevents them having to rip the pads off patients’ skin after surgery.

Stretcher chairs are motorized — ours feature a fifth wheel that drops down from the center of the base to help drive it forward — which allows a single nurse to maneuver a chair using push-button controls on its handles. That’s a big plus for the allocation of staffing resources from an efficiency standpoint. The height and articulation of the surface of the chairs can be adjusted with the push of a button, so a nurse can transition the patient from sitting in pre-op to supine in the OR and back to sitting in recovery. Additionally, the chairs can be programmed to five preset positions, meaning staff can reposition patients quickly and easily.

After a chair has been reclined into the flat position and patients are wheeled into the OR, I can use controls near the head of the chair or remote foot pedals to finetune the position of the headrest and articulate the height of the bed. This lets me make micro-adjustments to how the patient is positioned under the surgical microscope.

Multi-layered safety. Establishing a series of checks to ensure surgeons operate on the correct eye is, most importantly, an essential element of patient safety. A well thought out and effective process also lets staff and surgeons run through the series of steps in an engaged and efficient manner.

Have front desk workers verify the type of lens and the eye to be operated on with patients when they check in for surgery. Pre-op staff should confirm the same information as patients sign consent forms. Initiate an immediate hard stop when questions arise and clear up any confusion by reviewing notes made on the consent form, surgical schedule and patient’s chart. 

Place the patient’s identification band and a nametag on their wrist and shirt on the same side of the eye that will be operated on. Both forms of ID help staff members quickly confirm the patient’s name and correct eye at each stage of care.

QUICK REFERENCE Hanging a sheet that contains important clinical information on the surgical microscope adds to the efficiency and safety of surgery.

Spend the same time-saving attention on ensuring the correct IOL is implanted in the correct eye of the correct patient. This process must begin long before patients enter the OR. I review the charts of all my patients a week before their scheduled procedures to confirm the correct implant is noted on the operative form. I also handwrite pertinent clinical information on a sheet of paper that will travel with patients from pre-op to the OR. This form is called the “microscope sheet” and contains the patient’s name, age, hometown, referring physician, astigmatism values, targeted post-op refraction and the implant I’ll place during surgery. A staff member in my practice’s clinic prepopulates most of the demographic info on the sheet before I add the pre-op calculations and lens information. A third staff member verifies the accuracy of the sheet.

On the day of surgery, a pre-op nurse reviews and confirms the information on the scope sheet with the patient, pulls the implant needed for the case and places it in a bin attached to the side of the stretcher chair. In the OR, a surgical nurse and tech ensure the implant in the bin matches the power and type of lens noted on the scope sheet. When I arrive to operate, I confirm that the information on the sheet is correct one last time and lead the safety time out before beginning surgery.

Convenient storage. Stock general surgical supplies in a clean room just outside the ORs and keep often-used items in open cabinets within the rooms for easy access. Custom procedure packs filled with syringes, labels, cannulas and other products surgeons use during every case help speed room turnovers — our team can prepare ORs for the next case in about five minutes. Maintain a small stash of backup packs and commonly used instruments in the OR in the event items or tools are accidentally dropped during surgery.

Prepping pearls. The IV start is one of the most anxiety-producing aspects of cataract surgery, but the amount of discomfort — physical and mental — patients feel can be managed by clear communication and setting their expectations before the day of surgery. Flag patients who’ve had trouble having lines placed in the past and have nurses pay particular attention to making them feel comfortable and listening to their concerns. At our center, a nurse who excels at starting IVs handles the task for hesitant patients and another skilled member of the care team is ready to step in if first-stick success is not achieved. Of course, the pain of IV starts and the time needed to place a line could be avoided with oral sedation if your anesthesia care team feels comfortable managing the first-pass effect of metabolism.

NEXT IN LINE Patients who are prepped in pre-op are ready to be operated on as soon as they enter the OR.

Consider prepping patients’ eyes for surgery in pre-op before they enter the OR. We adopted this practice when pre-pandemic staffing issues forced us to open only one of the two ORs in our facility. With only one room in use, I found myself waiting to perform surgery while staff prepped the patient. It was a significant waste of time in a specialty where every minute counts.

In pre-op, patients now receive dilating and antibiotic drops. Nurses place a drop of lidocaine jelly in the eye and wipe it across the periocular skin tissue area several times with a cotton-tipped applicator. This standard prepping practice, which is clinically acceptable, can be used if you’re running behind — or even ahead — of schedule and need to move patients along to prevent a logjam.

If time permits, I prefer to wet a 4x4 gauze pad with diluted povidone-iodine, fold the pad into a quarter size, place it over the patient’s closed eyelid and leave it in place for at least five minutes. The prepping solution dries on the periocular area to provide a longer contact time, which we believe provides an additional layer of protection against post-op infection.

After being prepped in pre-op, patients are wheeled into the OR and the stretcher chair is rolled into place. The scrub tech opens the patient’s eye and applies the surgical drape. We review the information on the scope sheet and perform one last safety check. I’m ready to operate and in less than 10 minutes we’ll begin the process again. OSM

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