Potential operational efficiencies in routine cataract surgery associated with a new, preloaded intraocular lens delivery system

Session Details

Session Title: IOL Technology / Accommodative IOLs etc.

Session Date/Time: Saturday 13/09/2014 | 16:00-18:00

Paper Time: 17:36

Venue: Boulevard A

First Author: : S.Zaluski FRANCE

Co Author(s): :    D. Hardten              

Abstract Details

Purpose:

To identify and evaluate the potential operational efficiencies achieved when transitioning from manually-loaded intraocular lenses (IOLs) to the TECNIS iTec® preloaded IOL delivery system for routine cataract surgeries.

Setting:

VISIS Espace Mediterranee 66000 Perpignan, France

Methods:

Observational study results from a single site in Perpignan, France, shows comparison of intraoperative time and motion associated with cataract surgery workflows for cases utilizing manual versus preloaded IOL inserters. The study site used both the manual and the TECNIS iTec preloaded inserters for routine cataract surgeries during the study period. Time and motion measurements were recorded for a minimum of 20 manual and preloaded cases, respectively, performed in 2 operating rooms (ORs) by a single surgeon over 4 consecutive surgery days in October 2013. These measurements were taken for the intraoperative workflows of the surgeon, circulator, scrub technician, and cleaner/sterilizer, respectively, to identify potential operational efficiencies during OR setup, patient preparation, surgery, OR tear-down, and cleaning/sterilization. Overall differences in case time with manual vs. preloaded inserters were determined to evaluate potential opportunities for increased surgery throughput per day.

Results:

Of the 66 cataract cases performed, 47 met study inclusion criteria (27 manual, 20 preloaded). The study site employed a dual-OR setup, with a similar number of cases performed in each OR (OR1 = 24, OR2 = 23). With the preloaded inserter, the overall median time required to set up the OR decreased by 7.7% [manual = 08:27 (mm:ss), preloaded = 07:48], patient preparation time increased 5.8% [manual = 02:43 (mm:ss), preloaded = 02:52], surgery time decreased 8.6% [manual = 06:18 (mm:ss), preloaded = 05:45], and OR tear-down time was reduced by 4.5% [manual = 02:26 (mm:ss), preloaded = 02:20]. Overall median time to perform a cataract case was reduced by 5.1% with the preloaded inserter [manual = 20:08 (mm:ss), preloaded = 19:07]. With the preloaded inserter, median case time savings were 7.9% greater in OR2 as compared to 2014.03.10-RD8363 OR1 (OR1 = 00:33, OR2 = 02:01). The surgery staff assigned to OR2 had 17 more years of cumulative cataract experience than the staff in OR1 (OR1 = 16 years, OR2 = 33 years). Outside of the OR, the total time spent cleaning and sterilizing the surgery tools was reduced by 15.3% [manual = 09:35 (mm:ss), preloaded = 08:07].

Conclusions:

At a single ophthalmic clinic in Perpignan, France, switching from a manually-loaded IOL insertion system to a preloaded device for routine cataract surgeries reduced overall cataract case time by 5.1%. Assuming these findings are replicable at other clinics and surgery centers, those that perform 20 or more routine cataract cases on the same day could expect to save enough time to add at least one additional case per day.

Financial Interest:

One or more of the authors... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, One or more of the authors... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, One or more of the authors... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, One or more of the authors... receives consulting fees, retainer, or contract payments from a competing company