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Efficiency is Key to Treating Growing Number of Injection Patients
By Steve Lenier, Contributing Editor

The growing number of retina patients requiring anti-VEGF drug injection is a challenge for doctors.

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Increasing Efficiency
Two well-known retina specialists increased the size of their staffs to accommodate this growing patient population. Both say the increase was necessary but even more crucial is improving efficiency. David Brown, MD, of Retinal Consultants of Houston approached this issue from a "lean manufacturing" point of view. He evaluated the practice to identify any areas that could be streamlined to eliminate unnecessary or repetitive steps in the process.

Pravin Dugel, MD, managing partner of Retinal Consultants of Arizona in Phoenix, looked at ways to improve his practice's efficiency as well. "You have to have a routine that works for your office," he says.

Both doctors say that while the goal is getting patients through the system quickly, this can't be done in a way that decreases the level of patient care. "Efficiency is how you get a lot done and still take care of every single person properly and safely," says Dr. Dugel.

To increase efficiency, Dr. Brown says it's important to identify the rate-limiting factor in the process and speed it up to maximize throughput. He says utilizing as much of the doctor's time as possible is a major factor so as not to compromise doctor-patient interaction, which is what will ultimately provide the best care.

Dedicated Injection Days Not as Efficient
Drs. Dugel and Brown discovered that it's less efficient to have dedicated days or blocks of time for injection-only clinics, so both incorporate their injection patients into regular clinic days. One reason block scheduling doesn't work is that doctors don't always know if a patient will need an injection every time he comes in, especially in a treat-and-extend regimen. Additionally, it's not always convenient for each patient to have his appointment scheduled during defined times. And with different procedures taking different amounts of time, it's better if the workflow can be evened out over each hour and day. Dr. Brown said he's able to "backload" a clinic day to perform more injections at the end of the day, since the prep time for those patients takes more time than the actual injections.

Management of Staff and Time
The two doctors approach utilization of their technicians differently. Dr. Brown prefers to have his technicians cross-trained to perform work-ups, injection preparation, surgical education, OCT scans and so on. This allows him to use available manpower on whatever task needs to be done at that time. Dr. Dugel, on the other hand, identified certain technicians with a high level of interpersonal and technical skills to be trained as "special procedure people." These staff members prepare patients for injection, and Dr. Dugel moves between two rooms to administer the injections. While he performs an injection in one room, another patient is being prepped in the other room.

If you evaluate your practices policies, procedures and patient flow, then implement a process based on hard facts, you should be able to increase efficiency while continuing to provide top-notch patient care.

Retinal Physician | 323 Norristown Road, Suite 200, Ambler, PA 19002 | 215-646-8700
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