Finding ways to promote efficiency in the OR is increasingly important as surgeons find themselves with less time than ever before. For many, new devices and technology is helping maximize productivity. But surgeons say adding devices isn’t the only answer. It’s also evaluating innovative ways to streamline patient flow. Here, they offer their tried-and-true boosters.

The high-tech options

For high-volume, and outcome-driven cataract surgeons, a femtosecond laser has become a “necessity,” according to Robert J. Weinstock, MD, director of cataract and refractive surgery at The Eye Institute of West Florida and the Weinstock Laser Eye Center. Dr. Weinstock uses the Lensar Next-Gen laser, which he says promotes efficiency by eliminating the need for manual cornea markings.

“To be able to be in and out of the procedure room in 1 minute and already have the patient undergo astigmatism correction and have their capsulotomy performed is a significant time saver,” he says. “Instead of struggling through the manual markings, or doing extensive sculpting, an important amount of the procedure is already completed. Automating these steps means a lot less stress on the surgeon, which improves outcomes. Twenty manual capsulotomies or capsulectomies add up to mental and physical stress.”

Denise M. Visco, MD, MBA, medical director, Eyes of York in Pennsylvania, agrees that the Lensar laser has been a critical tool for executing procedures efficiently. Since the laser is integrated with the topography system, information is wirelessly transferred to the laser with no transcribing or uploading.

“It’s quicker to dock, quicker to move, and if you have more than one unit, you can do your laser under sterile conditions and streamline the process,” she explains. “There is no moving around and for staff it is one identification of the patient, and everything is completed in one spot.”

A Digital Suite can have some of the same benefits when it comes to streamlining operations. Scott LaBorwit, MD, founder of Select Eye Care in Maryland and assistant professor, part-time faculty at Wilmer Eye Clinic of Johns Hopkins Hospital says that their testing in the clinic transfers data and astigmatism information to the OR.

“This is imported via the web to our femtosecond laser, then into the OR for our ORA (Ocular Response Analyzer, Reichert), and then onto the Ngenuity 3D heads-up display (Alcon). The staff no longer has to put data into the three different pieces of equipment — the LenSx (Alcon), ORA and Ngenuity. It allows the surgeon to place a toric lens without using tools to identify the axis of astigmatism during the case. In a toric case, this saves the provider about two minutes and the staff about five minutes."

Dr. Visco adds that although it’s not a device, Omidria (phenylephrine and ketorolac, Rayner) intraocular solution helps improve thefficiency in cataract surgery by reducing the need for pupil-expansion devices and preventing intraoperative miosis.

“It makes the procedure go more efficiently and smoothly and provides better outcomes,” she adds. “Compounded post-operative drops also save time with the office staff on callbacks and prior authorizations. As surgeons, we also need to consider how time consuming post-operative care can be.”

But don’t overlook low-tech

Sometimes efficiency is also fostered by simple solutions — not just large investment devices. Dr. LaBorwit says that a remote doorbell helps maintain patient flow.

“When a surgeon places the IOL during surgery, the circulating nurse pushes a remote control that rings a doorbell plugged into an outlet in the hallway,” he explains. “This lets the laser room know the surgeon will arrive in about three minutes, the PACU [post-anesthesia care unit] knows the patient has finished surgery and will arrive in four minutes, and the second OR becomes aware of when to expect the surgeon.”

Dr. LaBorwit says this solved the problem of knowing when a surgeon will arrive at the next step. The tech can have the laser patient set up with photos completed and the speculum in, so when the doctors arrive, the patient is ready to dock and treat.

“Also, the second OR will drape and place the speculum, knowing the timing of the surgeon’s arrival,” he continues. “This saves about four to five minutes per case—and over 30 cases, that’s a big deal.”

For Dr. Weinstock, an elaborate video system helps with efficiency. In his practice you will find video cameras linked to the microscopes, with cameras in the OR, femtosecond laser room, pre-op, and post-op so that no matter where you are, you can see what’s going on in the rest of the building.

“It allows the surgeon to have a sense of the flow instead of having everyone operating in an isolated silo,” he says. “This is great for communication and connectivity, which ultimately improves our efficiency as it avoids bottlenecks.”

Of ergonomics and employees

Dr. Weinstock also says that using a 3D video system for heads-up surgery improves efficiency.

“Heads-up displays are obviously better for ergonomics, but there is a lot of time that goes into making adjustments to the chair to get everything into the right position,” he says. “When you’re in a comfortable position, you work more comfortably and efficiently and that leads to better outcomes.”

One efficiency enhancer is not a gadget. According to Michael Patterson, DO, managing partner at Eye Centers of Tennessee, and consulting physician at Cumberland Medical Center and Cookeville Regional Medical Center, sometimes the answer to efficiency has nothing to do with adding new technology or devices — but adding more people. He says it’s easy for surgeons to feel like they’re falling behind if they’re not adding the latest and greatest equipment, but they’ve improved efficiency with more ophthalmic techs and scribes.

“An employee that helps you work up just two more patients a day can help you turn more profit and improve outcomes, too,” he says. “I have four scribes. This means there is always someone with the patient and they are never waiting. This allows me to run six exam lanes seeing patients. It’s how I see 90 patients in a day and still finish by 4:30 with a 45-minute lunch.”

Like the doorbell or video systems that Drs. LaBorwit and Weinstock use (respectively), Dr. Patterson says he does use a lighting system that alerts him to what’s going on.

“I don’t have to wait for anyone to tell me where to go,” he says. “A fast-blinking light tells me that’s my next room. A red light means the patient is being talked to by a scribe or being prepped for an injection. It’s simple and efficient.”

Focus on what you can control

At the end of the day, Dr. Visco says efficiency boils down to finding what works best for your individual OR. Every situation is slightly different.

“There’s so much more to it than constantly turning toward what’s new,” sums up Dr. Patterson. “There’s always going to be a new device that promises to make you a little bit faster. But efficiency starts at the top with the doctor showing up early to clinic and setting the standard. It starts with having a goal and training a great support staff.” OASC