SDS Accreditation Update
19 practices ID'd that reduce cataract times
A new report has identified 19 practices that reduce facility times for ambulatory centers performing cataract extraction with lens insertion. The Cataract Extraction with Lens Insertion 2008 Report: Performance Measurement and Benchmarking in Ambulatory Organizations, is the ninth in a series of reports on cataract surgery conducted by the AAAHC Institute for Quality Improvement, a not-for-profit subsidiary of the Accreditation Association for Ambulatory Health Care.
"In the study, only procedure times are used for benchmarking because the processes involved are not dictated by clinical guidelines and are, for the most part, within the control of the organization," said Naomi Kuznets, PhD, managing director of the AAAHC institute. "They also are indicators of safety and patient satisfaction."
For example, pre-procedure or operating room "wait" times can be associated with patient satisfaction. Lengthy discharge times might indicate an overuse of medication during the procedure.
Organizations with the shortest times attributed their success to a variety of factors, including:
- As much paperwork as possible is completed when scheduling the patient.
- Patients are sent home from scheduling with a packet, including informed consent, anesthesia consent; visual function questionnaire, pre-surgery instructions, eyedrop prescription, and scheduler's business card.
- Patients are called prior to the day of surgery to remind them of pre-surgical eyedrop regimen, arrival time, and NPO status, and to answer their questions.
- At one organization, a special compound dilating solution is used. If the patient isn't completely dilated he/she is brought into the OR where the physician uses a numbing solution of 1% lidocaine and epinephrine, which completes dilation in a few seconds. At another, eyedrops are administered on patient arrival, and the physician uses Shugarcaine if the patient isn't dilated in 30 minutes.
- A pre-op nursing/anesthesia form is used so that the nurse's documentation of patient medications and history can be used by anesthesia staff.
- Patients are instructed to arrive in short-sleeve, button-down shirts, and not required to change into gowns.
- Patients are provided with postoperative instructions before surgery.
- Pre-op assessment forms, discharge forms, and routine orders are standardized.
- Local anesthesia and mild IV sedation are used.
- High-volume surgeons are given two operating rooms.
- Laser surgeries are done when all other surgeries are completed.
- Cases using a phacoemulsifier are scheduled first, and longer cases are scheduled at the end of the day.
- Staff members are cross-trained.
- A stretcher that converts to a chair is used for quick transfers.
- CRNAs keep patients stabilized in the OR and accompany them to recovery, and they stay with the patients until the physician clears them for discharge.
- A family member is with the patient at pre- or post-procedure to hear discharge instructions, confirm follow-up appointments, and address questions.
- Patients whose post-procedural vital signs are not stable or who have postoperative nausea are moved to another area for monitoring and care.
- Patients are offered water and juice (no snacks) before discharge.
- Patients are transported to their rides via wheelchair or by a dedicated post-op staff escort.
The 77 ambulatory organizations that participated perform from 64 to 12,000 cataract procedures each year. Study participants included 55 freestanding single specialty ambulatory surgery centers (ASCs), 17 multispecialty ASCs, and five office-based surgery practices. Eighty-three cases were listed as complicated or nonroutine and excluded from the analyses. The most frequent reasons for listing a case as complicated or nonroutine were associated with intraoperative floppy iris syndrome (IFIS).
To order copies of the report or for more information, visit www.aaahciqi.org and click on "Order Products." The Cataract Extraction with Lens Insertion 2008 Report CD-ROM is $110. The Cataract Extraction with Lens Insertion 2008 Report PDF is $85.
Average Times
Source: Cataract Extraction with Lens Insertion 2008 Report, AAAHC Institute for Quality Improvement. |
SDS Accreditation Update Patients report on their outcomes As part of the Cataract Extraction with Lens Insertion 2008 Report from the AAAHC Institute for Quality Improvement, about 82% of patients (1,418) were contacted within 14 days of their cataract procedures to obtain information about outcomes. While not every patient answered every question, here are their responses:
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