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Strategic Scheduling for Anti-VEGF Injections
With the right planning, you can increase injections without disturbing patient flow.
By Erin Murphy, Contributing Editor |
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How does your office schedule anti-VEGF injections? Whatever your approach, you’ve probably had cause to reconsider how you schedule injections in the last few years.
"We're using injections to treat more problems, including AMD, macular edema following retina vein occlusion and diabetic macular edema," says Peter K. Kaiser, MD, of the Cleveland Clinic's Cole Eye Institute. "Injections always required thoughtful scheduling, but now they can clog your clinic if you don't have a plan."
David M. Brown, MD, of Retina Consultants of Houston, says ophthalmologists are wondering how they can treat patients efficiently in the new paradigm of ongoing injections. He says, "Either we change our approach or patients will wait longer and longer and we'll get home later and later."
So, how can you fulfill the increasing demand for injections without forcing patients to wait and longer hours? Drs. Kaiser and Brown follow two very different strategies. Read on to decide which approach might work in your practice.
New Ways to Group Patients
At Cole Eye Institute, increasing injections have already changed the way patients are scheduled. "Scheduling injections like other appointments isn't feasible anymore," Dr. Kaiser explains. "Now we group the injection appointments together, so patients are treated quickly without affecting patient flow."
According to Dr. Kaiser, office managers at the Cole Eye Institute are working on additional scheduling changes. A dedicated clinic for injection patients is slated to open soon and will be organized around the injection workup to cut wait times. A pilot program involves an elective group appointment concept for AMD patients.
"We're stealing the idea from internal medicine, which has had success with this model here at the Cleveland Clinic," explains Dr. Kaiser. "We've seen that patient groups get more out of these visits — in particular, through supportive talks in the waiting room and group Q&A sessions. It's also a more predictable experience every month. And from an efficiency perspective, doctors answer common questions once instead of responding to each patient individually."
From Grouping to Staggering
At Retina Consultants of Houston, a different evolution has taken place. The practice had been stacking injections at the end of the morning or setting up afternoon sessions to coincide with times when technicians were less busy, but that could leave doctors waiting.
"Injections have a very high ratio of technician time to physician time. A new patient workup might take 15 minutes, while the injection interaction takes only a few minutes," Dr. Brown says. "To avoid wait time for the physician, you either need more technicians seeing more patients simultaneously or you need to stagger these patients throughout the day. We've chosen the latter as our current strategy."
Patient compliance and satisfaction also factor into Dr. Brown's scheduling approach. Because transportation is a challenge for many of these patients, 20% of his patients now undergo bilateral injections.
"It helps if a patient's daughter only has to take time off of work once a month instead of twice. In scheduling terms, that decreases our overall number of patient visits, but those visits need double the prep time," he explains. But double the prep shouldn't mean double the wait. "Patients should know how much wait time to expect so they can correctly schedule their transportation. For new patients and old, compliance with a recommended injection regiment often hinges on how smoothly routine injections are administered."
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