Interim results of time and motion study of delivering high volume cataract surgery using a femtosecond laser hub and spoke model compared to conventional phacoemulsification

Session Details

Session Title: Femtolaser-Assisted Cataract Surgery (FLACS) I

Session Date/Time: Sunday 08/10/2017 | 08:00-10:00

Paper Time: 08:12

Venue: Room 3.6

First Author: : D.O'Brart UK

Co Author(s): :    H. Roberts   V. Wagh   S. Borsci   M. Ni           

Abstract Details

Purpose:

To compare practical differences between conventional phacoemulsification surgery (CPS) and femtosecond laser assisted cataract surgery (FLACS) in a high volume service to determine whether a system of one femtosecond laser feeding patients to two theatres, a so-called hub-and-spoke model, can achieve increased productivity. This was conducted as part of a randomised controlled trial to achieve parity between the two groups of patients.

Setting:

St Thomas’ Hospital, London, UK.

Methods:

Patients were randomised to receive conventional phacoemulsification surgery (CPS) or femtosecond laser assisted cataract surgery (FLACS) within a dedicated high volume cataract surgery theatre session. Surgery was performed by 3 experienced FLACS surgeons. A hub-and-spoke model was based around one femtosecond laser (LenSx, Alcon Inc) operated by one ophthalmologist working independently, feeding treated patients into two operating theatres. In the CPS model, two theatres were run simultaneously and independently. Timings were performed by nursing staff experienced in cataract surgery.

Results:

167 patients were treated within a high volume setting over 10 half-day sessions. One additional member of staff was required to facilitate patient flow into the laser suite and subsequently into theatre. Patient time in the laser suite was 5.96minutes(min)±2.09. Surgical times were 10.8min±3.2 for FLACS compared to 13.6min±6.3 for CPS (P<0.001). There were no differences in patient time in theatre before the case (FLACS 5.9min±2.5 vs CPS 5.8min±2.7) or after the case (FLACS 2.3min±0.6 vs CPS 2.3min±0.6). Median number of cases per list was 9 for FLACS and 8 for CPS(p=0.79).

Conclusions:

Using a hub-and-spoke model, surgical times can be reduced by incorporating FLACS. In our service this translated on average into two additional cases per dual theatre list. Theoretical modelling based on this data shows that 3 theatres per laser would be the optimum number in a hub-and-spoke model, allowing the treatment of 3 extra cases.

Financial Disclosure:

research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented