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Efficiency in Cataract Surgery

The "Best Practices" highlighted below were collected last year in the latest in a series of surveys designed to identify efficiencies in procedures performed in ambulatory surgery centers under CPT code 66984 (cataract extraction with lens insertion). Surveys were conducted in 1999, 2000, 2002 and 2003 by the Performance Measurement Initiative, a quality improvement subsidiary of the Accreditation Association of Ambulatory Health Care (AAAHC).

The purpose of the surveys is to initiate clinical performance measurement on key processes and outcomes, and to help surgical teams use the information for clinical quality improvement.

	PHOTOGRAPHER: DEREK P REDFEAM/IMAGE BANK

Part of the rationale for studying this procedure is that cataract is the most frequent diagnosis associated with ambulatory surgery visits. The complete 2003 survey can be ordered for $50 plus shipping and handling through the AAAHC Web site (www.aaahciqi.org) or by calling (847) 853-6078.

Following are a number of Best Practices provided to the 2003 survey by ambulatory surgery organizations judged to have the most efficient procedures in place:

General Best Practices:

• Surgical teams with high efficiency ratings often said they operated single-specialty ASCs, with cataract surgery the primary procedure performed.
• Surgical teams with high efficiency ratings tended to use more than one operating room per surgeon.

Pre-Procedure:

• Surgeons should have an experienced pre-op staff trained to work effectively as a team.
• The surgical team should have a consistent pre-op routine.
• The pre-op team should thoroughly review the entire procedure with the patient at least 3 days prior to surgery.
• Patients can also be prescribed dilating drops, and begin using one drop in the operative eye every 30 minutes during the 3 hours before arriving at the ASC.

During the Procedure:

• Have each patient enter surgery thoroughly prepped.
• Have standardized instruments, supplies and equipment readily available to be used with each patient. The surgeon should never have to wait for instruments.
• Have standardized procedures so that each team member is totally familiar with his or her role.
• Cross-train staff to develop efficiency in setup and cleanup procedures.
• Surgeons and staff should be networking with -- and benchmarking -- peers from other practices who also perform cataract surgery in ASCs.

Discharge Procedure:

• Have standardized post-op routines.
• Nurses should closely monitor patients until they meet all discharge criteria.
• For those surgeons who are comfortable with it, the use of topical anesthetics allows patients to recover more quickly, creating efficiencies in the discharge process.

About this data: The AAAHC collected real-time data from February 2003 through May 2003 from 62 ambulatory surgery organizations that volunteered to participate. The study represented a total of 1,486 cases. Average patient age ranged from 65 to 77. Surgeons who perform cataract surgery in ASCs and who are interested in participating in the 2004 AAAHC Best Practices survey should call (847) 853-6078.