Dry eye disease (DED) is a chronic, multifactorial disease. Dry eye related symptoms are a common patient complaint in ophthalmology, and patients can be referred to a dry eye clinic for a variety of reasons: patient’s complaint, examination findings, or for treatment before or after undergoing an eye procedure, such as cataract or refractive surgery (see “DED and cataract/refractive surgery”). As the demand for effective dry eye treatment grows, so does the need for specialized and efficient dry eye clinics.

This article will present practical tips that have promoted efficiency in our clinic.

• Consider providing patient questionnaires prior to appointments. Obtaining a detailed chief complaint, in conjunction with the exam and testing, is invaluable in determining the cause of the patient’s symptoms. Is it blepharitis, meibomian gland dysfunction, or an auto-immune or inflammatory response?

Arriving at the chief complaint can be time-consuming. To increase efficiency, consider asking the patient to fill out a questionnaire, which can expedite and guide the process. The questionnaire can be individualized, based on doctor preference, and given at check-in, mailed to the patient, or made available on a secure patient portal. Input the completed questionnaire in the patient’s chart.

A variety of DED questionnaires are available, such as the National Eye Institute Visual Function Questionnaire-25 (see bit.ly/3avIPRr ) and Ocular Surface Disease Index (OSDI), created by Allergan (see bit.ly/35DBSvt ).

• Conduct a thorough medical history. A thorough medical history is as important as the chief complaint. The history should record: medical conditions for which the patient is being followed, previous eye surgeries, history of dry eye treatments at other clinics, brand names of over-the counter treatments used, etc. Also obtain a list of allergies, including any to tea tree oil, as this is a common treatment for Demodex.

Errors or gaps in the history can decrease efficiency, for example, when the doctor pauses to correct charting during a review of the medical history with the patient.

• Provide work-up technicians with a doctor’s preference list. Treatment plans for DED can vary depending on the doctor and diagnosis. Consider having common treatment plans available for technicians to reference to expedite the work-up process. These treatment plans should include each doctor’s preference in artificial tears brands, nutritional supplements, warm compresses/heat mask, and Demodex treatment products. Document any brands the patient is using in the chart and, carefully review the doctor’s previous treatment plan with the patient.

• Establish a proper and consistent training program for the dry eye staff. A knowledgeable technician promotes patient confidence in care throughout the examination process; when follow-up instructions are not clear, it can cause inefficiencies and longer patient wait times.

Ensure each technician working in the dry eye clinic has proper and consistent training, specifically geared towards DED. Each technician should be familiar with the EMR system, doctor’s preferences, work-up steps (which often excludes eyedrops instilled in clinic), dry eye equipment operation/maintenance, and common treatment plans.

• When establishing a dry eye clinic, choose experienced technicians. Consider staffing with experienced technicians, scribes, and trainers to increase efficiency in a newly-established clinic. It is beneficial if they are familiar with cataract and refractive pre-surgical measuring devices. As efficiency increases and troubleshooting decreases, then train in new staff.

• Establish effective communication procedures with the doctor and all staff. The management team should be open to staff suggestions. There is always room for improvement, and the technician may identify patient concerns, as some patients may be more willing to mention complaints to the technician versus completing a patient survey. Occasional short meetings at the end of morning or end of day with dry eye clinic staff and doctors can ensure everyone is on the same page with new equipment, exam protocols, and treatment plans. Remember, teamwork is vital when it comes to increasing dry eye clinic efficiency.

• Regularly audit charts to ensure accuracy. As always, increasing efficiency is secondary to providing optimal patient care. Audit charts on a regular basis to ensure errors are not increasing and documentation is meeting doctor expectations. OP