Eyeworld

March 2017 • Ophthalmology Business 7 "If you have someone who is a smart scheduler, like I have, they can pick up on pitfalls ahead of time. You need someone with the right person- ality and attention to detail," he said. A scheduler should not only have a good understanding of the patient's ophthalmic needs, but also his or her systemic health conditions. If a patient is on dialysis Monday/ Wednesday/Friday at a location 4 hours away from the surgery center, for example, the scheduler should know not to schedule surgery on those days. "The person scheduling the cases is key," Dr. Dalla said. With all of these measures in place, Dr. Norris said it's rare that a surgery gets cancelled. If he deems it necessary to delay or cancel a surgery, he said it is a "simple, honest, direct conversation" with the ophthalmol- ogist. "They know if we come to them with a concern, it's not that we want to cancel a case or get out; we just want to do what's best for the patient and what's best for them as a sur- geon," Dr. Norris said. OB References 1. Henderson BA, et al. Incidence and causes of ocular surgery cancellations in an ambula- tory surgical center. J Cataract Refract Surg. 2006;32:95–102. 2. Bamashmus M, et al. Why is cataract sur- gery canceled? A retrospective evaluation. Eur J Ophthalmol. 2010;20:101–5. Editors' note: The sources have no finan- cial interests related to their comments. Contact information Dalla: kumardalla@hotmail.com Damiano: info@neivision.com Norris: davidnorrismd@yahoo.com off work or someone took a day off work to come with them, so it's more than just us or the surgeon [a cancel- lation is] inconveniencing," he said. While reorganizing the schedule is, of course, not ideal, Dr. Dalla said it's better than cancelling completely and having a wasted spot. Not only does it save the patient time in the long run, but Dr. Dalla noted that a surgical kit might have already been opened or a special lens ordered, so keeping the surgery on the same day, if possible, is an advantage. While patient safety is the number one priority, Dr. Dalla said if the patient's health condition can be managed and re-evaluated, the case could possibly be done the same day with some scheduling shuffling. Other reasons for cancellation include a conflict in the patient's day-of-surgery caregiver's schedule and weather/transportation issues. Yet another possible reason for cancellation, Ms. Damiano said, is an inability to pay. To further prevent issues that could cancel or delay surgeries, Dr. Norris said about 10 years ago he helped establish a preoperative assessment anesthesia clinic, which includes an in-person meeting or phone call with the patient a cou- ple of days ahead of surgery. This meeting instructs the patient on NPO guidelines, medications they should or should not take, and more. Timing of the surgery day-of will also be scheduled based on the patient's needs to better ensure it goes off without a hitch. Children, diabetics, and others who need more medical management are scheduled for sur- gery earlier in the day. Dr. Dalla said a good scheduler is also critical. guidelines or they have uncontrolled glucose or blood pressure levels when they arrive. A study published in the Europe- an Journal of Ophthalmology for elec- tive cataract surgery between 2001 and 2003, involving 1,952 patients, found 12% of cases were cancelled with the main medical reasons being systemic hypertension and improper control of diabetes. 2 "Regardless of the type of anes- thesia they're going to get, whether it's a general anesthetic or a block, we usually like to have those things under better control before we go to the OR," Dr. Norris said. Kumar Dalla, MD, Vitreo-Ret- inal Consultants, Wichita, Kansas, agreed that other health issues are often the driving factor for surgical cancellations, which he noted occur in about 5 to 10% of his cases each month. If possible, Dr. Norris said he'll try to normalize these patients to only delay their surgery until later that day, rather than cancel and reschedule it. "If there is time in the day, we'll try to rearrange the order of the cases.… Push them toward the end of the day, rearrange the schedule, and try to get their blood sugar, for exam- ple, under better control. That's just our philosophy; I know some other anesthesiologists might disagree with that," Dr. Norris said. "We want to get [patients'] surgeries done to the best of everyone's ability. "[Cancellations are] an incon- venience for everyone. We lose out on the room time. We usually don't have another case to put in, so there is lost productivity. Then there is the inconvenience for the patient and their family. They either took a day cancellations

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