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20 cataracts a day for surgeons on cataract ‘production line'
In an innovative move, about half of the ophthalmologists at Sunderland Eye Infirmary's Cataract Treatment Centre are performing about 100 cataract operations per week, said David Allen , FRCOphth, an ophthalmologist at the Sunderland centre. "We're able to get 20 cataracts a day, but only half the work in our unit is high-volume," "The other half is normal volume because those surgeons are teaching. One of the important issues is that if you are doing high volume, you can't teach. But it is important that there are teaching lists also in that unit," he explained. Dr Allen, who is one of those on the production line, says such an arrangement suits his talents. "I'm not good at hands-on teaching, but I can teach outside the theatre. So it would be a waste of my skills to slow down to teach." Such a high-volume centre requires a highly efficient system. As an ophthalmologist finishes the surgery, a nurse is completing the operation record. The surgeon merely checks the record and signs off. "It takes five seconds, I also help to wheel the patient out; we don't wait for porters; we have the patient on mobile operating trolleys, and they are brought to the recovery area," says Dr Allen.Video cameras and monitors ensure that staff members outside the operating theatre know when an operation is finished. There's a monitor in the anaesthetic room so that the patient is ready to come in when the patient who has just been operated on clears the theatre, he noted, adding: "So the nurse who is with the next patient sees the surgery coming to an end and preps the operating site, and the patient gets wheeled in just as the other is going out." Patients are brought in before equipment is changed, saving time."Some unit's insist on changing everything before the patient is wheeled in and then you have further delays. It's all about streamlining," said Dr Allen. Just like a production line—but with one important difference. "It doesn't feel like a production line to the patient because the same nurse accompanies the patient through all stages of the procedure," said Allen.The centre has extended the role of ophthalmic nurses to allow them to take on some of the consultant's functions. For instance, nurses take patient histories, check for suitability of anaesthetics, gauge anxiety levels, assess the need for sedation, and perform the eye examination and biometry. They can also run post-operative clinics. Nurses are also multi-skilled in theatre, so when they are not visiting or running post-op clinics, they are assisting operations. They handle the surgery list. Each surgeon has his/her own team of nurses run by a team leader and because they know how that surgeon works they are able to adjust the operating list to make sure things run as smoothly as possible, allocating double slots for complicated cases and making sure complicated cases do not run together. A recent addition to the duties of some of the nurses is obtaining the patient's consent to the operation. The nurse explains the procedure, including potential risks, says Kath Stoddart, an ophthalmic nurse and assistant nurse manager with the centre. "We have a list of competencies to allow the nurse to consent," she added. Although Sunderland has been successful, Dr. Allen cautions that it cannot be applied everywhere. "There is a great danger in finding a model that works, in one setting, in one set of circumstances, with a history that's relative to that unit. There is a danger in saying, 'because that works there, it must be used everywhere.' You can't have a one-size fits-all model," he said.
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