COVID-19’s impact on ophthalmic surgical centers

By James D. Dawes, MHA, COE, CMPE

Last year, something happened that we never expected and never built into any contingency or business plans: We had to stop performing elective surgery.

If I had written in January 2020 that you should plan for your outpatient ASCs to be closed for two to three months to elective surgery, most would have considered me to be out of my mind. Well, it happened! So, what do ophthalmic ASCs look like now in the peri-pandemic world?

I asked Cathy Perry, RN, vice president of Surgical Services at Center For Sight, Sarasota, FL, who oversees three large and busy ASCs about her thoughts, and she offered the following insights:

1 PPE shortages

Even today, there are sometimes shortages of personal protective equipment (PPE), in particular, gloves in the right size. For decades we all took well-fitting gloves for granted. Now, we understand they are a luxury that must be protected! Surgeons tend to be creatures of habit. They like their surgical routine to be the same. Consistency produces better outcomes, right? They have their favorite gloves, masks, etc. When something in that routine changes, it creates disruption in their specific surgical routine and that can create frustration and mistakes. While I have found the many ophthalmologists I’ve worked with to be amazingly flexible, understanding and cooperative in these times of added stress, ASC managers and staff will have to continue to be cognizant of PPE supply for the foreseeable future.

2 Change of surgical pace

Some of the high volume and routine laser cases, such as YAG lasers, can no longer be performed at the previous pace. YAG lasers, in particular, have often been structured into block “laser” sessions in ophthalmic ASCs. High volume centers may perform up to 25 to 30 YAGs in a given session. However, now with social distancing and the requirement of room sterilization between patients, it takes more time in block sessions to complete the same volume of procedures. Simple math demonstrates that the block formula may be less profitable for certain procedures and new scheduling procedures will need to be implemented.

3 Device representatives access

Device manufacturers and, to some degree, pharmaceutical representatives, have had direct access to the ASCs and operating rooms. Device representatives play a crucial role in educating surgeons on new products and technology. While ophthalmic ASCs have mostly re-opened their doors to necessary device representatives, access is restricted on who can and cannot enter the ASC and operating rooms. As facilities introduce new medical device technology, they have to plan around the logistics of who can be in the operating rooms and when they can be there.

4 Post-operative patient education

Many facilities limit guests and caregivers from entering the ASC. While this is helpful in limiting the spread of disease, it can complicate patient care. In particular, post-operative instructions which, prior to the pandemic, were often shared with family or caregivers now may only be shared with the patient. In ophthalmic surgical procedures there may be several drops required over an extended period of time with a somewhat complicated regimen. As health care personnel, we have to ensure that our patients understand their post-operative instructions and have easy-to-understand, simple and informative postoperative materials. In order to simplify the drop regimen, many surgeons are combining drops into a single bottle format. Some are even texting the patients reminders of when to take what medications post-operatively.

5 Staffing and team retention

Lastly, the pandemic has helped us to understand the value of our teams. Many team members have struggled with providing care to family members affected by the pandemic and helping their children with home-based learning. When our trained and experienced teams cannot be working, it creates a tremendous void in the surgical process. This has been a valuable human resources lesson for all of us. And it has helped us realize that we have to be accommodating and supportive of our staff members and their needs in order to retain quality team members. OP