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Efficiency in Cataract Surgery

The "Best Practices" highlighted below were collected in 2004 in the latest in a series of annual surveys designed to identify efficiencies in procedures performed in ambulatory surgery centers under CPT code 66984 (cataract extraction with lens insertion). Surveys have been conducted by the Performance Measurement Initiative, a quality improvement subsidiary of the Accreditation Association of Ambulatory Health Care (AAAHC).

The purpose is to initiate clinical performance measurement on key processes and outcomes, and to help surgical teams use the information for clinical quality improvement. Practices participating in past surveys have reported that adopting recommended efficiencies has helped them to significantly reduce overall time spent in the ASC.

The complete 2004 survey can be ordered for $50 plus shipping and handling by clicking on the "Institute" icon on the AAAHC Web site, www.aaahc.org.

Following are a number of Best Practices provided to the 2004 survey by ambulatory surgery organizations judged to have the most efficient procedures in place:

General Best Practices:

► Surgical teams with high efficiency ratings often operate 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:

► Practices with the lowest pre-procedure times were well-staffed. The practice with the lowest pre-procedure time in the survey performs well under 2,000 cataract procedures per year, yet uses three RNs and four techs in a facility with two operating rooms, two pre-op bays and two recovery bays.

► Low pre-procedure times correlate with evaluating and pre-registering patients a week before surgery, having standing pre-op orders, and the timely administration of eye drops.

During the Procedure:

► Have each patient enter surgery thoroughly prepped.

► Have standardized instruments, supplies and equipment readily available to be used with each patient. When all surgeons in a practice use the same instruments, the evidence suggests that the organization can reduce procedure time and also save money.

► For practices using more than one operating room, minimize the time that a ready room isn't being used. Idle operating rooms jeopardize productivity.

Discharge Procedure:

► Nurses should closely monitor patients until they meet all discharge criteria. In one highly efficient practice, when vital signs are similar to admission vital signs, the IV is discontinued and the patient is taken to the kitchen for nourishment and discharge instructions.

► 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 May 2004 through September 2004 from 71 ambulatory surgery organizations that volunteered to participate. The participating practices perform more than 134,000 cataract procedures annually, with procedure volume per-practice ranging from 200 to 8,777 annually. This study represented a total of 1,724 cases. Surgeons who perform cataract surgery in ASCs and who are interested in participating in the 2005 AAAHC Best Practices survey should call (847) 853-6078.