Eyeworld

EW CATARACT 28 November 2018 a method of checking the operation details. P: Patient detail, F: correct Formula, E: which Eye, L: Lens type, and T: Target refraction," Dr. Rosen said. "There is also 'The Productive Operating Theatre,' which is based on efficient operating lists that lead to surgeries that are more produc- tive, more cost effective, safer, and make happier patients and staff. Finally, key performance indicators (KPIs) help to improve efficiency based on the motto 'If it's measured, it will improve.' These include: op- eration start and finish times, time into and out of the OR, turnaround time (time patient is out of the OR to the time of the next anesthesia), time utilization (minutes in session divided by minutes used), number of cases completed safely and effi- ciently, complications, patient sat- isfaction, and surgeon satisfaction." It is very important that the drive for efficiency does not compromise safety and outcome. Barriers to efficient surgery include: poor pre-assessment (high cancellation rate), ineffective planning, bad ergonomics of the OR suite, poor teamwork, and slow, inefficient, and unproductive oper- ating lists. Dr. Rosen thinks that a profes- sional, multi-skilled, and flexible team that knows its job and the re- sponsibilities of those around them are the makings of a successful, safe, ergonomic surgical experience. The environment and equipment, patient positioning, and the sur- geon's operating position all have to be correct. The surgeon and staff need to be aware of how sensitive patients will be to the wrong word, sound, or vibe in the OR. "It's not just about the surgeon; we are only part of a team. Simple things matter a lot, and we need to support each other while we are operating to improve safety, efficiency, and out- comes," he said. EW Editors' note: Dr. Rosen has no finan- cial interests related to his comments. Contact information Rosen: phrosen@rocketmail.com lens, which could happen when more lenses are being prepared for upcoming surgeries. Prevention of wrong IOL insertion (distinct from refractive surprise) involves: repeated checks and a WHO check (biometry check, patient verification in the anesthesia room, check the correct formula, check toric and special lens calcula- tions, verify choice with colleague, and sign off). In the operating room, preventive measures include writing relevant information on the white board and training and empowering the nurses in reviewing biometry to help spot errors. "There are many ways that different facilities have tried to im- prove safety and efficiency. At Moor- fields, they coined the expression 'Patients From England Like Tea' as Ergonomics continued from page 26 causes. Etiologies may include: bi- ometry measurement errors, lack of training in the use of specific IOLs, wrong patient/wrong biometry printout, human error in looking at printout, mental math (surgeon fac- tor), misuse of electronic patient re- cords (wrong patient, transcription error, multiple records open), and selecting and picking up the wrong

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