Eliminate unnecessary tests, streamline pre-op
Surgery is a time of anxiety for anyone, but for older patients, a long day of visiting different departments and undergoing different tests can be excruciating. For this reason, the ophthalmologists and anesthesiologists at Scott and White in Temple, TX, developed a fast-track pre-op process for their cataract patients.
"Patients would spend 60 to 90 minutes in surgery and recovery on the day of surgery, but they’d spend a full eight hours the day before going through our pre-op process," says Doug Davis, MD, senior staff physician at Scott and White.
"By the time they made it to the anesthesiologist, the last stop of the day, they were angry, tired, and frustrated," he says. "The anesthesiologists agreed when I suggested that we could find a better way to handle pre-op for cataract patients because they always had to deal with complaining, angry patients."
The first step in streamlining the process was to look at how things were done and see what could be eliminated, explains Davis. "We had always required the patients to see their primary care physician prior to surgery, but if they’ve been seen within the last six weeks, we just call the primary care physician to make sure they are able to undergo surgery."
The anesthesiologists also agreed to take on additional assessment responsibilities in order to eliminate some diagnostic tests. Instead of automatically ordering EKGs for all patients, the anesthesiologist now performs a cardiorespiratory exam on the patient on the morning of surgery. If the anesthesiologist wants an EKG, it is performed while the patient’s eyes are dilating in preparation for the surgery.
"We also dropped chest X-rays because they didn’t give us any information related to the surgery," says Davis. "We also stopped automatically ordering blood work that included tests such as electrolytes and complete blood counts. Now, we order the test if the patient has a specific condition, such as being diuretic, that requires us to know certain serum levels." Davis estimates that less than 30% of his cataract patients require lab tests.
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