For years, our practice blocked off one hour for pre-op for each of our cataract surgery patients. Usually, this hour visit was sufficient for both the necessary testing and patient counseling/education. However, the education occasionally took longer than we had planned. This resulted in appointments running past the allotted hour, which caused a significant bottleneck in the schedule.

To assist with education, the ophthalmologists and technicians designed multiple handouts with all the pertinent information the patient would need to understand the process of preparing for and having surgery. All the forms were placed nicely into a folder and handed to the patient at the end of the visit. At checkout, we scheduled their pre-op and surgery dates. Unfortunately, this folder was often lost or never read by the patient.

Consequently, at the in-person pre-op, we would perform all the necessary measurements and explain the preparation for surgery and the surgery procedure, review intraocular lens (IOL) options, get an H&P, or history and physical, discuss the process at the surgery center, get a patient signature on consent, and review all surgery dates and appointments for follow-up.

As you can imagine, the patients and their families could remember only small portions of what was said in the pre-op, even though we gave them written instructions. The next time we would see the patient following these appointments would be at the surgery center. As such, we would get a significant share of patients calling back with questions before surgery, often in the middle of a busy clinic day.

While approaches to educate and counsel patients may differ from practice to practice, our practice has made the following changes to address the above challenges and improve the education process.

Change the pace

Our practice decided to separate the in-person pre-op measurements from the cataract discussion, which now would be done by phone prior to the pre-op visit. We designated a seasoned ophthalmic technician who had previous experience doing pre-ops and surgery experience as the surgical educator. However, with proper training, many experienced technicians may be willing to assume this role.

The goal of the surgical educator is to convey the practice’s goals of:

• Educating all cataract surgery patients so they fully understand the complete cataract procedure and IOL options
• Managing patient expectations
• Increasing efficiency at the office and surgery center.

Before scheduling the "pre-talk"

When our front desk staff schedule the patient for cataract surgery, they produce a paper with all the information regarding name, date of birth, chart number, eye schedule, and the dates and times of all appointments. The paper is then passed to our billing person, who does the insurance pre-authorization and notates any out-of-pocket charges. Then, the billing person makes a paper chart, attaches the date sheet with insurance information, and provides this information to the surgical educator.

Armed with this information, the surgical educator then prepares the surgical file. This paper file includes an H&P, a sheet for the operative report, the past visit printed out from the electronic medical record, the proper consent forms, and a biographical sheet with all patient information and any notes about the patient (Figure 1). The ophthalmologist will usually write a note to the surgical educator and the technicians regarding their recommended IOL choice(s) for the patient. The surgical educator will then add the IOL information to their notes to help steer the patient toward the best option for them. Our goal with available lens choices is always to choose what is in the patient's best interest, what they think they want, and our knowledge of their eye conditions. With all the above information assembled in the surgical file, the educator is now prepared to schedule the call.

We text the patient to schedule the “pre-talk” call about 1-2 weeks before the in-person pre-op and 3-4 weeks before the surgery dates. This strategy has proven to keep us in the minds of our surgery patients, and they reciprocate by following our suggestions and directions well.

The “pre-talk” call

At the beginning of the appointed phone call, the surgical educator tells the patient that this time is for them. They can ask questions, and, as the educator, I will give them the best information, so they are comfortable with the whole cataract surgery process. Calls last an average of 28 minutes. (The most extended call I ever had was 52 minutes. You all know the one who talks over you and talks some more.)

During the phone call, the surgical educator performs the steps below. Note that these steps may vary from practice to practice and can be adjusted to meet the needs of various practice’s protocols.

• Discusses pre-op and post-op medications, reviews IOL options, reviews dates and times of all upcoming appointments, and, most importantly, answers those burning questions that the patient and family members present on the call.
• Handwrites notes on the same biographical sheet mentioned above. The pre-op tech can read it and use the information while seeing the patient during their in-person pre-op.
• Uses a check-off sheet at the in-person pre-op (Figure 2). The surgical educator can help by asking the patient some of these necessary questions from the pre-op checklist, especially if the patient desires a premium IOL. By following this checklist, surgical educators can better control patient expectations with lens choices for and guide their decision process. 

• Reviews the need to use preservative-free artificial tears (ATs) two to three times a day before the pre-op. The tears are needed, because dry eye will cause inaccurate corneal measurement. I explain that we will do a mapping of the corneal surface at their preop visit and will be able to tell if the cornea is dry. If it is, we schedule the patient to return a few days later for repeat measurements. This thought usually persuades patients to use the drops. I add that when they start using the medicated drops, pre- and post-op, the ATs will soothe an irritated eye during the healing process.
• Provides Medicare patients with the appropriate questionnaire. Medicare requires a questionnaire, showing the patient has valid complaints about their vision, be placed in the patient’s record. I review the need for them to fill it out after the call and return it at the in-person pre-op.
• Reviews the cataract post-op medication chart that the patient will use to keep track of their medication schedule. For our patients, this is a simple Excel sheet that our practice — with patient input — has developed into an easy-to-follow check-off sheet (Figure 3).

• Reviews the patient's current medication usage as well. We ask our patients on diuretics not to take them on the morning of surgery. We also ask our patients who are on GLP1 agonists (Figure 4) to discontinue taking these medications for one week before surgery. These medications slow down digestion, and our anesthesiologist requires an empty stomach for the safety of the patient if general anesthesia is needed. Patients seldom require general anesthesia, but it is best to be prepared. Our patients are most understanding and comply with the instructions.

• Reviews the surgery day process. The surgical educator takes the patient step-by-step on what to expect on surgery day, including how long they will be at the surgery center, where to go, what to wear, and other details that specify what will happen prior to and after surgery. For example, we ask the patient to wear slacks, comfortable shoes, and a button-down shirt/blouse so they will not have to pull anything over their head. 

Conclusion

Since instituting the role of surgical educator, everyone involved with cataract surgery has been happier. Our practice ophthalmologists have been pleased, as patients are more at ease and cooperative because they are properly educated. Ophthalmic technicians have reduced the time to do in-person pre-op to about 15-30 minutes, allowing them to focus on the crucial measurements. The surgical educator is happy to help ease any anxiety felt by the patient, doctor, and/or surgical coordinator. And patients feel like we are going above and beyond to help them navigate the surgical journey. OP