PHOTOGRAPHY BY ERIK HINOTE PHOTOGRAPHY

“Leave no man behind” has long been a tenet of the U.S. military. Almost 2 years ago, Northwest Eye Specialists, a two-location ophthalmology practice, in Tucson, AZ, adapted a similar policy when it took on an additional 25 to 30 glaucoma patients per week from a local retiring ophthalmologist. Talk about pressure! (Pun intended.)

“There was a large demand,” explains Michael Henry, MD, a board-certified, fellowship-trained cataract and glaucoma surgeon at the practice, who, in part, commanded this influx. “These patients needed a home, so we decided we were going to provide one for them.”

Here, members of the allied health staff who work in the trenches discuss how Northwest Eye Specialists integrated these patients into the practice without sacrificing high-quality patient care or disrupting clinic flow.

Cross-training

Realizing flexibility would be required to take on so many new patients and maintain first-class patient care, both the allied health staff and the glaucoma specialists devised a plan for comprehensive cross-training in the glaucoma portion of the practice, says Jeanette Thomas, COA, a tech and scribe at the practice.

“We’ve all worked really hard to learn how to answer phones, operate the different diagnostic devices, chart, and assist the doctors and each other with technology operation,” she explains. “There is a real team mentality here.”

Brittany Kain, COA, a scribe at the practice, says allied health team may jump in to enter a patient’s medical history.

“We all learned how to do this, as well as check the patient portal for incoming information,” she affirms. “You won’t find any staff members checking their phones or waiting around. We are all very cognizant of making ourselves available to each other.”

During cross-training, senior technicians show newer staff the operation of devices, such as the Zeiss Humphrey Visual Field Analyzer 3, explaining the technology’s purpose and how to educate patients on the value of the technology. In addition, newer techs shadow senior techs during patient visits. When needed, senior techs also role play, acting as patients before the newer techs start operating the technology on their own. This hands-on training takes roughly a month, says Ms. Thomas.

Offer live pre-registration

To help maintain clinic flow, allied health staff also put in place the idea of offering live, pre-registration, says Melyssa Badillo, COA. “While the practice makes patient intake/history forms available on the practice website and mails these forms, we recognized that many patients were coming to their appointments without completing their paperwork. This behavior could put a major dent in the schedule, which would then cut down on that doctor face time that patients value, so we came up with the idea of having a staff person acquire this information from patients via phone a day or two before their appointment.”

The result: About 20 minutes were cut from the workup time because both the allied health staff and doctors knew ahead of the appointment precisely what testing would be needed, Ms. Badillo says.

Create glaucoma evaluation slots

The allied health staff also devised the idea to create specific glaucoma evaluation slots in the practice schedule, so those additional glaucoma patients wouldn’t have to wait for appointments and the patient schedule wouldn’t be thrown off.

“We [allied health staff] broached the idea of designating glaucoma evaluation slots that would occur post-surgery when the doctors typically took the rest of the day off,” Ms. Badillo explains.

The outcome of this idea: The doctors were able to perform six to eight glaucoma evaluations per session of post-surgery clinics.

“Many of these patients were worried about getting their medications refilled as well as learning about whether their glaucoma had progressed, so they were extremely grateful that we were able to see them relatively quickly,” notes Dr. Henry.

Abbreviated workups

In addition to creating more evaluation slots, Ms. Kain says that allied health staff, in working with the glaucoma specialists, created a list of essential testing per patient type to allow for more glaucoma evaluation appointments without sacrificing stellar patient care or interfering with the schedule.

“For example, if a patient’s external record shows their pachymetry, OCT, and/or central corneal thickness was documented within the last couple months, we knew there was no reason to acquire this information so soon,” she asserts. “Additionally, we found that these abbreviated workups showed incoming patients we valued their time, which can and has created patient loyalty to the practice."

Another instance: In knowing a post-cataract surgery patient has age-related macular degeneration and glaucoma, and their best-corrected vision was always going to be 20/100, allied health staff knew a detailed refraction wasn’t necessary, Ms. Kain says. Time-consuming refractions for BCVA could be referred to an internal or patient preferred optometrist.

Ms. Kain adds that staff implemented a time cap on repeat testing, as they noted some glaucoma patients could become fatigued, which could affect result accuracy and clinic flow.

“If there were several false positives on a patient’s visual field, for example, the doctor didn’t have that patient sit there for 20 minutes until he got what he was looking for,” she says. “Instead, the patient would return on a different day. That was a win for everyone.”

Answer patient questions

Another idea to enable the addition of these glaucoma patients without sacrificing five-star patient care or the patient schedule was having the techs and scribes answer patient questions regarding the prescribed management, explains Ms. Badillo.

Ms. Thomas provides this example: “If the doctor suggested Durysta (bimatoprost intracameral implant, Allergan), he would explain that it’s an implant designed to decrease the patient’s eye pressure, and then we [allied health staff] would stay behind to answer questions such as, 'Will I feel it?' and 'Can it fall out?' so the patient received the response, and the doctor could stay on schedule,” she says.

Allied health staff were able to answer common patient questions through training. During a monthly, one-hour educational staff meeting, doctors discussed related treatments in terms of purpose, side effects, and anything else a patient might ask, points out Ms. Badillo. This staff education continues.

“Education has come in the form of videos, slide shows, lectures, and more, and ‘Jeopardy’-type questions and related gift certificates have been used to promote staff recall,” she explains. “The practice also provided and still provides a free, ongoing program called ‘Tech U,’ which affords a continuing medical education credit allied health staff can use toward different certifications that not only increase their knowledge base but also their salary at the practice.”

Ms. Thomas notes one Tech U session focused on minimally invasive glaucoma surgery, or MIGS procedures, in terms of how the stents worked and were placed, which prepared staff for questions from patients.

“The doctors were and are always encouraging allied health staff to move up in their careers, and they enable us to get the experience required by IJCAHPO in the practice, which is huge!” points out Ms. Kain.

In this together

Roughly 2 years later, Northwest Eye Specialists’ staff continue to use the ideas that enabled them to leave no glaucoma patient behind in the other areas of the practice. Additionally, they are sure to never leave each other behind, asserts Ms. Badillo.

“We all genuinely care about each other and helping each other out,” she says. “Everyone is on the same page about providing stellar patient care and is a valued member of the team.” OP