Transforming Ontario's Health Care System Care Stories

Efficiently Helping Patients See Clearly

Winifred Burke was anxious prior to her cataract surgery. "I was a bundle of nerves," the 83-year-old, recalled. But that changed by the time she left the Cataract Suite at St. Joseph's Health Care in London, Ontario where she had surgery on her right eye.

"The minute a nurse came to prepare me for surgery everything changed. I felt like I was lying there with everyone from the palace looking after me. Everything about the procedure was quick, smooth and calm," Burke said.

Michelle Mahood, director of ambulatory surgery at St. Joseph's Health Care London's Cataract Suite and Ivey Eye Institute, explained it takes planning, dedication and commitment from all staff to ensure every cataract patient has a similar experience to Burke. "We have a high satisfaction level. Patients are in and out in 1 1/2 hours. But they don't feel rushed and they express incredible gratitude," Mahood said.

The hospital has been on a continuous quality improvement mission since the Ivey Eye Institute was formed in 2001 through its amalgamation with the former Victoria Hospital Campus Eye Clinic at London Health Sciences Centre and the Eye Clinic at St. Joseph's Hospital. Five years ago the dedicated Cataract Suite was established.

"Previously cataract surgery was done in the hospital's main operating room. Setting up a dedicated cataract suite, including pre and post-op areas, with consistent clinical staff was a vast improvement," Dr. Merchea, medical director of the Cataract Suite said. "It increased accessibility for patients, improved efficiency, enhanced quality of care and reduced cost."

The cataract facility has two operating theatres, dedicated staff, supplies and sterile reprocessing.

Dr. Merchea's team was already engaged in quality improvement analysis when the Ministry of Health and Long-Term Care established provincial, evidence-based targets for single cataract procedures to align with Health System Funding Reform (HSFR).

"The Cataract Suite team analyzed our cost per case and identified efficiencies, while supporting quality care. Our first priority is always the patient experience and outcome," Mahood said.

The team's efforts lowered the average direct cost of a single cataract procedure from $587 to below the provincial target of $497. "They came up with improvement ideas and are always looking for efficiencies. There is a shared leadership model here and everyone has an equal voice in generating creative ideas," Mahood explained.

The Cataract Suite found efficiencies by standardizing surgical instrument trays and the use of pharmaceuticals as well as working with its vendor on lens costs.

The team reduced the variability in the instruments used to perform cataract surgeries. The push from HSFR to further streamline based on evidence has resulted in a surgical instrument tray of 14 items, down from 45 items, used consistently by the facility's 10 surgeons.

Single sterile package items are available for the odd time a surgeon may require an instrument not included in the standardized tray. "The use of standardized trays saw savings in the reprocessing, replacement and repair of equipment. It also decreased set up time," Mahood said.

The team also decided to switch from the cataract lens it had been using, which had some enhanced features that were not medically necessary. When renegotiating with its vendor, the Cataract Suite secured another state-of-the art lens at a lower cost. An analysis was done of other supplies and pharmaceuticals in use and further adjustments were made. "We streamlined medication based on evidence," Dr. Merchea explained.

The team is sharing their experience with other areas of the hospital. "Clinicians and staff are interested in standardizing our approach for other procedures within the organization to proactively position us for fiscal sustainability," Mahood said. "We're redefining acute ambulatory care and looking at how we leverage what we've already achieved."

Meanwhile, Burke confidently arrived at the Cataract Suite for her left eye. "Everyone was there to look after me. I was again really impressed by their efficiency and how they all worked together," Burke said.

"For at least 10 years I was losing some sharpness of vision. Now I'm ready to look at the world and see everything clearly."

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