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Deconstruction of the Office: Diagnostic services
In past installments, we have discussed issues of great importance to the practicing physician, such as the number of exam rooms the doctor might need, how they might be laid out and where they should be located in the facility. One of the more complicating factors in ophthalmology offices is diagnostic services. Short of the practice adding more providers, the increase in the number and types of diagnostic tests being offered causes as many space-related convulsions as anything else. The doctor goes to an ophthalmology meeting, sees the latest whiz-bang and wants to add it to the practice.
From Medical Design International’s perspective, there are three categories of diagnostic services that must be wrestled with when planning an ophthalmology office. These are:
- Quick tests that are done on many patients on the way to the exam room
- Tests that are performed by the physician
- Tests that are ordered by the doctor but performed by staff
Let’s discuss the practice and patient flow implications of each of these categories in your office.
Quick tests
Typically, this refers to autorefraction and autokeratometry. Practices often perform these tests on patients who will be seen by the doctor. The tests are relatively quick and are done by the doctor’s technicians as part of the workup process before the patient is brought to the exam room. For this reason, MDI generally locates the autorefractor and autokeratometer in an alcove between the waiting room and the exam room. The staff member stops off while taking the patient back, does the test and then takes the patient to the exam room with the test results.
Because this is a quick test and is part of the patient workup by the technician, it can generally be done without interrupting the doctor’s flow.
Physician diagnostic tests
This represents diagnostic tests that involve the physician to some extent, including B-scans (if the doctor does not delegate this to a diagnostic technician), fluorescein angiography (if the doctor injects) and lasers. These pieces of equipment need to be located near where the physician works because these tests are physician-performed and, as we have stressed in earlier articles, it is very important to help the doctor be as productive as possible. It is far better to have the staff walk to the physician than have the physician walk to the equipment and staff when they are remotely located.
Staff diagnostic tests
These are tests performed by staff without the physician’s direct involvement. This category can include biometry, visual field tests, fundus photography, fluorescein angiography (if the tests with injections are delegated to staff) and a number of other tests. This is the diagnostic services category that seems to grow every year with new, must-have equipment.
It is important to locate this equipment in a common area that can be supervised by technicians yet is not underfoot of the practicing doctors. Patients undergoing these diagnostic services do not need to intrude upon the doctor’s flow. It will just congest the doctor’s workspace, making it more difficult for him or her to stay on track.
With this in mind, clients frequently wonder how many diagnostic rooms to have. MDI recommends having at least as many as the number of technicians who will be doing such tests simultaneously. MDI does not recommend that all the equipment be put in one large room. This makes it more difficult for staff to get patients in and out quickly because the room may already be occupied by another patient and another technician.
There also is an additional factor that comes into play. If you have a diagnostic test that will take a long time — visual fields is the most common test that we run into — then MDI recommends this be performed in a dedicated room. This will allow other technicians to use the remaining equipment on an as-needed basis and without a long wait.
An example of the organization that we have been discussing here is demonstrated in the Figure below.
Notice that diagnostic patients are at the left end of this diagram. The doctors in the routine of seeing patients are not aware of these diagnostic patients. If doctors have to go to the laser area, they are going in the opposite direction from the diagnostic service area.
Diagnostic staffing
A word about staffing for diagnostic tests is appropriate. It is common in ophthalmology offices for doctors to decide that they want a test done and then tell their technicians to do it. The technician and patient go off to the correct piece of equipment and perform the test. This simple directive keeps the tech busy and gets the test done, but it can cause havoc on flow through the office. The doctor’s entire production sequence is based on having tech support. The tech may work the patient up, refract the patient, scribe for the doctor and finish up with the patient after the doctor is done. The doctor’s ability to be productive is intimately intertwined with the production of these techs. When a technician is sent off to do a diagnostic study, the doctor may then be understaffed. As a result, the doctor’s pace slows down. Patients are not brought back into the clinic as quickly as expected. The waiting room backs up. After all, when the appointment template was set up and filled in, no one realized that the technician doing a diagnostic study would not be available. Overall, patient time in the office rises unnecessarily. And on top of that, the parking lot can back up too.
Thus, be careful before sending your personal technician off to do a diagnostic study. You may want to staff the diagnostic department with dedicated technicians for that day. Even if the techs are not 100% busy, if they allow the doctor to stay maximally busy, it may be in the practice’s interest to have them dedicated to diagnostics anyhow. Some practices schedule diagnostic tests such as visual fields at the end of a session or on a day when the doctor is not in the office seeing patients.
So, buy all the equipment you want. Bring it into your office. This is very important to a state-of-the-art ophthalmology practice. Just be careful how you deploy the performance of these tests in your office.
Richard C. Haines Jr. can be reached at Medical Design International, 2526 Mount Vernon Rd., Suite B-405, Atlanta, GA 30338; 770-409-8123; fax: 770-409-8662; email: haines@mdiatlanta.com.
Kurtis Grant can be reached at Medical Design International, 2526 Mount Vernon Rd., Suite B-405, Atlanta, GA 30338; 770-409-8123; fax: 770-409-8662; email: grant@mdiatlanta.com.