Ophthalmologists Drive Efficiency in the OR: Why It Matters

Special for Ophthalmology time®

In the operating room, every second counts. Complications lead to stress, pressure and clinical and financial consequences. An ideal operating environment is one that helps surgeons and surgical staff make the right decision, at the right time, with minimal physical and cognitive attrition.

At the Cleveland Eye Clinic, we perform many cataract and refractive surgeries every day. Investing time, strategy and resources in improving efficiency has helped us streamline our operations, meet unexpected challenges with confidence and treat more patients, while delivering quality care. If your organization is looking to do the same, here are a few things to remember.

Pay attention to logistics

To cultivate efficiency, OR logistics is your best place to start. Often we focus primarily on the clinical value of an asset and consider logistics secondarily. In practice, convenience and ease of implementation are mission critical attributes.

Implementing pre-loaded or pre-calibrated tools and devices is a good way to streamline unnecessary activities and preserve both time and focus. Single-use devices have become a staple in cataract surgery and refractive surgery in recent years and represent a step in the right direction. Preloaded intraocular lenses (IOLs) have proven to be extremely useful, eliminating the considerable stress associated with technician loads, syringe management and associated staff training. Eliminating these staffing burdens has given us back time, focus and energy, which we can gratefully invest in other clinical areas. We frequently use the IPure Preloaded Monofocal IOL (BVI), which offers high stability both short and long term, likely due to the stiffer hydrophobic acrylic material from which the lens is made. Its pre-charged injection system is predictable and efficient.

In our practice, we have gone further in streamlining by having all of our surgical tools delivered to our practice, including knives, fluid control devices, etc. ; BVI). This has allowed us to further optimize time and resources, as the time required to set up and take down the OR is drastically reduced. It also eliminates doubts in the heat of a particularly charged moment; when a critical tool is needed, we know it’s on the table and don’t have to factor in the possibility of human error in the setup phase. Custom packs are pre-sterilized and diapers are pre-folded to your exact needs, saving considerable time by eliminating the pre-use sterilization step.

When choosing drugs for surgery, one should also think about properties that could provide benefits beyond therapeutic efficacy. For example, we use a compound sublingual formulation for subconscious sedation, midazolam/ketamine HCI/ondansetron (MKO Melt; ImprimisRx) in the operating room that reduces or eliminates the need for intravenous anesthesia, allowing for saving nurses (and the healthcare system at large) considerable time and resources. Choosing a drug that effectively negates a preparatory step is an easy way to gain efficiency, but ultimately you need to weigh many factors to determine the best fit for your needs.

Information is essential

Beyond logistics, the surgeon and OR staff must be able to access and share critical information intuitively. Recently, advanced OR visualization systems have made this much easier, allowing robust, detail-rich visuals to be shared in real time, as well as integrating information from large and normally disparate displays, such as our aberrometer.

Having high-quality information accessible in one place, and by the entire surgical team, has made communication easier and more rewarding, helping us provide exceptional routine care and better manage complications when they arise. In our practice, we have implemented such a system (Ngenuity 3D Visualization System; Alcon), but several are now coming to market, including the Beyeonics One (Beyeonics Surgical; distributed by BVI in the US), which includes a removable holder for a non-contact wide-angle near-eye lens for posterior segment surgeries, and the Artevo 800 (Carl Zeiss Meditec), both of which sound great.

Parting Thoughts

While patient well-being and clinical outcomes remain our primary focus, staying efficient is an important way to minimize the challenges, stressors and costs that come with a hectic day in the operating room. By paying attention to logistics and implementing tools that facilitate them, as well as using and communicating the most reliable information possible, we can provide patients with consistent and quality results; improve the experience of our valued staff; and making our own lives easier in the process.

William F. Wiley, MD
Email: [email protected]
Wiley practices at the Cleveland Eye Clinic in northeast Ohio.

Christine E. Phillips