Cataract professionals share their secrets
Cataract professionals share their secrets
It’s a record that would make any same-day surgery provider envious: 45,000 cataract extractions, and no admissions to a hospital based on anesthesia complications.
The secret? An efficient cataract preoperative and perioperative process that incorporates reduced preoperative testing, involvement of the general practitioner, efficient scheduling, and focus on the patient.
Gimbel Eye Centre in Calgary, Canada, has been offering cataract extractions for 13 years and sees up to 4,000 patients per year. Here are ideas the center shares to ensure the preoperative and perioperative processes flow smoothly:
• Preoperative testing was reduced, and the general practitioner is involved.
When patients are having cataract extractions at Gimbel Eye Centre, the general practitioners (GPs) do the preoperative assessments. A letter sent to the GPs informs them that the preoperative testing is left to their discretion. A checklist is included on the back of the letter for GPs to use in their assessments.
Transferring responsibilities to the GPs has resulted in fewer tests, including chest X-rays, being conducted prior to surgery. (See letter to family doctor and checklist, enclosed in this issue.)
"We had to simplify the process," says Robert (Roy) C. Hamilton, MB, Bch, anesthesiologist at the Gimbel Eye Centre. "We thought there was a lot of overkill and excessive preop testing for what was an outpatient operation with patients here less than two hours." Hamilton is also one of the authors of Ophthalmic Anaesthesia (Arnold, London).
The letter from the center also informs GPs that there is no need for patients to discontinue anticoagulants or to fast preoperatively. The center has seen less nausea in the post-op recovery area since adding these instructions, says Janelle Weller, RN, coordinator of the cataract care track.
"We have more problems with people who have quit, for example, their diabetes medications or fasted, because they’re not feeling too good if they haven’t eaten," Weller says. "The surgery is not as much a problem as the peripherals that we impose on people," she says.
• The cataract clinic sees only preoperative assessments and emergencies the day before surgeries are scheduled.
At the cataract clinic in the center, all patients go through preoperative ophthalmology testing. Patients fill out a questionnaire for anesthesia. (See form, inserted in this issue.)
Setting aside time to conduct these tests has helped the preoperative process, because the staff focus on these patients, Weller says.
For example, the day before surgery, the cataract clinic is open only for assessments and emergency patients. On other days, the clinic offers YAG laser procedures, sees postoperative patients, and performs assessments that don’t involve surgery.
"We try to prioritize our time," Weller says.
• The focus is on the patient.
The center has a designated patient education staff member who offers detailed information on the patient’s eye condition, visual aids that explain the procedure, and answers to patients’ questions. Families are allowed to stay with patients virtually every step of the way during the preoperative ophthalmology testing and the surgery.
Elderly cataract patients need to be reminded to tell providers if there’s anything they’re unhappy about, Hamilton emphasizes. It’s particularly important to give elderly people "permission" to speak up, because they tend not to be as vocal as younger patients, Weller points out.
Hamilton says, "One thing we often say, is that, We want no surprises for you. We want you to be part of the team. During surgery, if there’s anything you don’t like, tell us, and we can immediately make it right, rather than waiting until one-half hour later."
These instructions help to alleviate stress, Hamilton points out, which can yield better surgical outcomes.
• The center keeps the perioperative process simple.
During the procedure, IVs are not routinely used. Patients wear their own clothes with booties over their shoes. They walk into the OR, where they sit in a dental-type chair and are covered with sterile drapes. (See Block Room and Operating Room Record, enclosed in this issue.)
"The goal is to always do what’s best for patient and disrupt their lives as little as possible," Weller says.
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