Practice strategies can help maintain high efficiency, quality care
Click Here to Manage Email Alerts
The COVID-19 pandemic has forced changes to practice routines that, in many cases, have come at the expense of efficiency.
During (and perhaps even beyond) the period of vaccine rollout, the need for these changes will remain in order to protect our many high-risk patients, including those with diabetes.
At Austin Retina Associates, efficiency procedures implemented before the pandemic have allowed us to maintain high-quality, efficient patient interactions without increasing risk for COVID-19 exposure. Two strategies in particular — lean process improvement and interdisciplinary imaging-based telemedicine — have lowered exposure risk and increased efficiency.
Lean process improvement
Lean process improvement enables our team to process patients more efficiently. Three tactics may help identify process improvements in your practice: spaghetti mapping, value stream mapping and bottleneck analysis.
Spaghetti maps track clinician and staff movement throughout the office, identifying where the practice spends time in transit. Our staff donned pedometers when we spaghetti mapped our office, and we found that they walked approximately 6 miles per day. After analyzing routes used on a routine day, we adjusted our footprint to keep small teams in separate corners of the office, resulting in a significantly lower distance traveled per day to 2 miles.
Value stream maps track patients throughout their visit and analyze patient stops to determine how much of the visit adds value (eg, undergoing examination) or detracts value (eg, sitting in the waiting room). These data lead to an adjustment in the order of workflow as well as increased communication and accountability, which lead to significantly reduced patient wait times during their clinic stay.
Bottleneck analyses are conducted after value stream mapping to identify areas of resistance to throughput. For example, if patients generally hit a snag during their visit at imaging, solutions such as purchasing technology or rearranging the steps of a visit can be implemented to correct the bottleneck.
In our practice, for example, per COVID protocols, a patient with diabetic retinopathy (DR) checks in by phone and waits in the car until a text message prompts them to enter the office and proceed directly to imaging. Using the Silverstone (Optos), a technician captures ultra-widefield (UWF) retinal photos and OCT scans. Our Optos technology is the only platform that provides a single-capture image showing 200° of the retina in less than 0.5 seconds and can be equipped with UWF-guided swept-source OCT. After imaging is complete, the patient meets the clinician. In this model, patients experience little downtime, fewer points of contact and a brief visit — something our patients appreciate.
Interdisciplinary imaging-based telemedicine
To reach patients with diabetes who are not receiving ophthalmic care, our team partners with nearby primary care physician (PCP) offices to offer DR screening. The PCP practices increase reimbursement-related quality scores by offering DR screening for patients with diabetes, and the patients benefit from earlier detection of treatable DR and possibly reduce their need for another doctor’s appointment. We formed a network with them that benefits the PCP offices, our practice and patients.
Source: Jose Agustin Martinez, MD
These PCP offices use single-field fundus photography to screen asymptomatic patients with diabetes for DR, and we review the images through a third-party platform. If abnormalities are detected, the patients typically visit our clinic for UWF imaging and examination. During their visit, UWF imaging allows us to gather more data on the patient’s condition and to quickly initiate a treatment strategy.
UWF and even seven standard field (7SF) imaging are preferred to single-field imaging for DR assessment. UWF imaging is best, however, as disease that may go undetected with single-field or 7SF imaging can be caught on UWF (Figure). Still, by setting up a network with PCPs who use single-field imaging, we identify and reach patients with confirmed disease at risk for DR progression who would otherwise remain untreated. Over time, PCPs may upgrade to UWF imaging because more pathology will be detected.
By screening in PCP clinics, most patients with diabetes seen in our clinics have DR already documented, thus reducing the number of patients with diabetes visiting our practice for screening only. This increases our capacity to see patients in need of treatment, which is especially important during the pandemic.
You can do it, too
Savvy clinicians will find the strategies outlined in this article useful even after the pandemic subsides. The initial investment of time and energy may seem daunting, but the payoff makes the effort worthwhile.
- For more information:
- Jose Agustin Martinez, MD, is a vitreoretinal surgeon at Austin Retina Associates, 801 W. 38th St., Suite 200, Austin, TX 78705; email: jmartinez@austinretina.com.
Collapse
Read more about
Click Here to Manage Email Alerts