Eyeworld

Methods for making laser-assisted cataract surgery fit in your practice 4 by Gary Foster, MD Plan for preparation: Practice flow efficiency with laser-assisted cataract surgery If one surgeon operates from two operating rooms, the femto- second laser decreases the overall throughput. However, the overall throughput increases if two sur- geons work as a team—with one performing laser procedures and the other removing the cataract and implanting the intraocular lens. 2 Surgeons also may increase efficiency by grouping LACS pro- cedures at certain times of day or on specific days of the week. 2 This approach allows efficiencies in laser warm-up time and laser-spe- cific staffing. To determine which arrangement works best in an individual practice, Hansen et al. recommended conducting a time analysis. 2 Surgeons do not need to begrudge slower overall case times with LACS if they select appropriate fees that provide fair reimbursement for their time. Conclusion Once you choose to commit to LACS, it is vital to map out a plan for efficiency by training your staff to be engaged in the process, providing uniform messaging, and carefully orchestrating your surgical flow. In addition, I rec- ommend making the most of ad- vanced technology and formulas, which will increase your chance of hitting the patient's refractive target the first time. References 1. Donaldson KE, et al. Femtosecond laser-assisted surgery. J Cataract Refract Surg. 2013;39:1753–1763. It is also helpful to recom- mend a specific course of action to patients. Ophthalmologists often offer patients a full range of choices but stop short of making a recommendation, which may disappoint those who are looking for guidance. If we understand patients' lifestyles and refractive goals, we know which option will be most likely to provide the vision they seek. Our advice will place the patient in the best position to make an informed decision. Surgical flow Surgeon time for LACS is largely based on the operating room structure. If a surgeon uses one operating room and the laser is in the OR, the laser portion is performed and then it takes 3 to 4 minutes to place the patient under the microscope, prep/drape him or her, and begin cataract removal. This slows the surgeon's throughput. However, if the laser is outside the operating room, surgeons often can proceed at their standard cataract surgery pace. The surgeon can perform the laser procedure on patient A, move to the operating room to finish a case, return to the laser to perform this part of the procedure on patient B, and then return to the operating room to complete cataract surgery on patient A. In this scenario, the laser portion of the case can be completed during the surgeon's standard turnover time. For greater efficiency, surgeons and staff need to embrace technology, intensify patient education, and streamline protocols T ransitioning to laser-as- sisted cataract surgery (LACS) impacts cataract practices in numer- ous ways. 1 To achieve efficiency when providing this procedure, surgeons need to take a multi-pronged approach (Figure 1). 2 The first step is for clinicians to commit to becoming excellent LACS surgeons. Secondly, the surgeon and staff need to be in Practice pearl: The most important step in successful laser-assisted cataract surgery implementation is a definitive and consistent commitment from the surgeon. Careful staff education on the bene- fits of LACS allows the staff to arrive at a similar level of commitment and creates consistent education and communication to the patient about the procedure from the front desk all the way to bill- ing. Optimized flow patterns through the OR and appro- priate billing practices ensure the operational efficiency of the procedure. –Gary Foster, MD " Staff take their cue from clinicians, so surgeon commitment is essential. " –Gary Foster, MD lock-step as they embrace this change. Next, the practice should establish a flow pattern that facilitates preoperative patient education and streamlines the process on the day of surgery. Commitment to LACS Staff take their cue from clini- cians, so surgeon commitment is essential. If surgeons are tepid one week about LACS but enthusiastic the next, staff will be confused and efficiency will decline. Surgeons need to meet with all staff who interact with pa- tients. Practices achieve the best possible outcomes when phy- sicians take the time to explain the science of the technology, based on published papers that support their decision. 3–6 If staff understands the science, they will be more accurate and better equipped to answer questions. During these meetings, surgeons need to clearly articulate the emphasis the practice will place on LACS and the consistent messaging that should be com- municated to patients. Without this level of train- ing, surgeons will find pockets of resistance and mixed messaging among staff members, and pa- tients will become confused. This confusion decreases patient con- fidence and can affect their final satisfaction and even outcome. Laying the groundwork Surgeons can increase efficiency as we educate patients and guide them through the decision-mak- ing process. Some parts of the preopera- tive process are best performed by the surgeon and others by trained staff. Since I began emailing educational materials to patients before appointments and asking technicians to review options with patients, administer lifestyle questionnaires, and present videos, patients have become well educated about their alternatives by the time they meet me.

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