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Keep accurate account of enhancement rate with detailed patient records, surgeon says
A monthly log of laser procedures can help surgeons see trends in their surgical outcomes and prevent false tallies of enhancement rates.
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Surgeons can maintain an accurate record of their enhancement rates by keeping a monthly log of laser procedures, outcomes and surgical criteria, according to Daniel S. Durrie, MD.
In an interview with Ocular Surgery News, Dr. Durrie stressed the importance of recording the dates of surgical procedures, enhancements and upgrades a database or spreadsheet to streamline office documentation and keep track of enhancement rates.
“Many people like to quote their enhancement rates,” said Dr. Durrie, OSN’s Refractive Surgery Section Editor. “But often times, these numbers aren’t accurate or correct because surgeons haven’t established a criterion or system of checks and balances to ensure that their enhancement procedures are properly documented and their rate of procedures are correctly calculated.”
He said enhancement rates can be calculated accurately with a computer spreadsheet program, such as Excel. “A spreadsheet calculates the figures for you and enables you to draw percentages from the data submitted,” Dr. Durrie explained.
He said the information provided to surgeons can offer valuable feedback about their surgical outcomes and follow-up procedures, which can be communicated to patients or used to evaluate surgical progress over time.
“You want longitudinal data of your enhancements,” Dr. Durrie said. “It’s important to watch your rate of enhancements over time to see if your outcomes are consistent, if your rates are decreasing, and most importantly, if you’re improving in your surgical skill.”
Proper documentation
In his Overland Park, Kan., refractive surgery center, Dr. Durrie enlists the help of staff members to keep track of all laser procedures.
“A nurse or technician records how many surgical procedures are performed each month, and then months or years later when an enhancement is performed we record it in the month that the original procedure is performed. Then you can have an accurate running total over time, ” he said.
The registry should also differentiate between different types of re-treatments, he said.
Dr. Durrie calls a re-treatment an “enhancement” if he is using the same procedure to reach the original goal of the procedure. He defines an upgrade as a procedure requested by former patients or new patients who have undergone refractive surgery in the past and desire improved visual performance with a new surgical procedure. He noted that patients requesting wavefront-guided treatments or upgrades are often patients who underwent LASIK before custom ablation was FDA-approved or who are now presbyopic.
When a current patient undergoes an enhancement, the date is noted in the registry next to the date of the first procedure. If the individual is a new patient and not already in the registry, the patient is noted as a new patient; this procedure is not calculated into the overall enhancement rate, Dr. Durrie explained.
“Calculating a referral patient into the registry will falsely skew your enhancement rate, making it higher than it actually is,” he noted.
Break down by subgroup
Dr. Durrie advises surgeons to break down their classifications when documenting procedures to get a more accurate account of enhancement rates. For example, he said that specifying which laser was used in a multilaser practice helps surgeons differentiate enhancement rates between lasers.
“Put your entries into subgroups,” Dr. Durrie said. “For more than one laser, note when laser A, B or C is used. Also, break down your patient groups, having separate categories for myopes, hyperopes and patients with astigmatism.”
Dr. Durrie differentiates between surgery types by noting a patient’s refractive error. Patients with low myopia, between 0 D to 3 D, who underwent laser ablation are grouped together; patients with moderate myopia between 4 D to 7 D; and high myopia between 7 D and 10 D are also grouped separately. Hyperopic patients are grouped into categories of 0 D to 2 D or 2 D to 4 D.
By correlating enhancement rates to refractive errors, surgeons can have a good idea of a patient’s surgical prognosis, Dr. Durrie said.
“When you know what your average rate of enhancements is for a certain error, you can look at a patient and say ‘Oh, you’re a high myope. My enhancement rate for high myopes is 5%. But my overall enhancement rate is just 2%,’” he said.
| Dr. Durrie defines surgical terminology for the clinic: | ||
Enhancements – “A fancy word for ‘re-do,’ ‘re-operation.’ An enhancement is needed if the laser was off target during the first ablation and left the patient with unintended aberrations.” (In his office, Dr. Durrie usually includes a free enhancement procedure for every patient who undergoes laser ablation. Enhancements usually take place 3 to 6 months after surgery.) Upgrades – “Surgically ‘upgrading’ or improving your vision with a new procedure after you’ve already had refractive surgery. Upgrades are like going from standard television to high-definition digital television.” (Dr. Durrie offers a 50% discount to former refractive surgery patients who want to “upgrade” their vision.) Bioptics/Staged Surgery – “A set of planned procedures, which both the patient and the surgeon are aware of prior to surgery. Bioptics usually mixes two types of refractive surgery, like phakic IOL implantation and laser ablation.” (Dr. Durrie offers a 50% discount to bioptics patients on their second surgery after they have paid full price for the first surgery.) |
![Daniel S. Durrie, MD [photo]](/images/commonart/durrie.jpg)
Be conscientious
Dr. Durrie said that it is important to keep good surgical records, so that when the time comes to disclose information, physicians can be confident of their reports.
He said that breaking down surgeries by subgroups in the registry and differentiating between new patients and current patients who undergo enhancements is vital to ensuring accuracy in enhancement rate reporting.
“Not keeping good records or including enhancements of patients who never underwent primary surgery in your center are sure-fire ways to distort your enhancement rates," Dr. Durrie said.
For Your Information:
- Daniel S. Durrie, MD, can be reached at Durrie Vision, 5520 College Blvd., Suite 200, Overland Park, KS 66211; 913-491-3737; fax: 913-491-9650; e-mail: ddurrie@durrievision.com.
- Nicole Nader is an OSN Staff Writer who covers all aspects of ophthalmology, specializing in pediatrics/strabismus and neuro-ophthalmology.