FEMTO FACTOR

How we added LACS without adding time

Don’t let implementation of femtosecond laser slow you down for a minute.

By Scott LaBorwit, MD

It may seem overwhelming at first for a cataract surgeon to consider the additional time necessary to implement the femtosecond laser. Chair time with patients is valuable and femto introduces yet another component to explain and discuss with them.

Also, femto requires two procedures in the OR. However, putting in some time initially to create efficient systems and build teams to support these systems will preserve your time interacting with patients in both the office and OR.

ASSIGN ROLES

The first step is to assign specific roles to each team member to effectively communicate to cataract surgery patients. We found it most efficient to schedule cataract evaluations in sessions. This allows staff to gather all the necessary tests while educating patients in a controlled and relaxed atmosphere.

Adopting femto and keeping on schedule with cataract surgeries is possible.

In the past, when cataract patients were randomly mixed into the schedule, the work-ups were not always consistent and complete and disrupted my schedule. Scheduling in sessions now allows me to train key staff to help with some of the patient education components.

Here is how it works: as the patient is dilating, a technician will introduce the concept of LACS and explain the general benefits and reasons our practice offers this technology. The technician is naturally a good communicator and has been trained extensively in LACS to convey a message similar to my personal beliefs.

Having my team gather all the data necessary to discuss surgical plans and introduce technology available to patients before I meet with them allows my time with patients to be efficient and focused.

MY ROLE IN THE DISCUSSION

If the patient is a candidate for LACS, I discuss the technology components along with the risks and benefits of LACS. I explain the key steps the laser does in the surgery and then why I recommend this technology for cataract surgery. This typically only takes about a minute of my exam for this topic.

I do not discuss price and do not ask the patient if they want to have LACS. Patients next meet with my surgical coordinator, who explains costs and asks patients what they would like to do. This allows the exam room to be a place for medical decision-making and my surgical coordinator to handle financial decisions. Additionally, we prefer to not discuss price until the patient meets with our surgical coordinator because we’ve found that patients listen better.

NOT ADDING MORE TIME

Adding another procedure before entering the OR can drastically reduce the number of procedures you do each day. I’ve addressed this by placing the laser in a procedure room rather than the OR and scheduling all LACS consecutively before all other cataract operations.

I start the day with two lasers in a row before I go into the OR for the first lens removal. This priming of the system permits me to perform my femtosecond cases while the OR is turning over, keeping me busy and not adding extra time in my day to perform the laser.

Several key parts are necessary for this to work. Technicians operate and coordinate the femtosecond laser. They greet the patients and explain what to expect during the laser procedure while answering any questions.

PREP DURING TURNOVER

Next, they wheel the patient into the laser room and input the patient information in the laser’s computer. The circulating nurse rings a wireless doorbell as a warning that I should be done in the OR and entering the laser room in approximately two minutes.

This signals the laser room technician to instill the topical anesthetic, place the lid speculum and raise the bed into position for the patient in the laser room.

All this prep work allows me to walk into the room, perform a time out, dock the PI and treat. I am typically in the laser room about three minutes, enough time for the OR team to turn it over.

I find using the techs from my office in the surgical center offers continuity between the two settings for patients. Additionally, the techs are more familiar with astigmatism measurements and previous conversations with patients than the surgical center team meeting patients for the first time. This efficiency allows me to perform 15 LACS cases typically by noon each day in my one-room OR.

Incorporating the femtosecond laser into your practice can be done efficiently and not slow down your day. It does require creating systems and training staff to adopt a team approach to patient care. In the end, you should find it rewarding, creating a balance in the office and surgical center. OM

Scott LaBorwit, MD, is a principal at Select Eye Care, with locations in Towson and Elkridge, Md., and is an assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com. Disclosures: Dr. LaBorwit is a consultant to and speaker for Alcon.