40 - TWO TABLES, ONE GOAL: ISBCS Efficiency Through Standardization of Dual Table Set-up

Description: Immediate Sequential Bilateral Cataract Surgery (ISBCS) is a surgical technique that involves operating on both eyes in the same surgical session. In the United States, a few organizations explored ISBCS due to U.S. Medicare Reimbursement issues and surgeons' hesitation about its rare potential complications. However, Dickman et al. (2022) conducted a systematic review comparing ISBCS to delayed bilateral cataract surgery (DSBCS); the outcome showed no clinical differences but a lower cost for ISBCS. Moreover, several articles emphasized the importance of safety during ISBCS by utilizing separate instrumentation and sterile supplies for each eye. However, there are no specific standards or guidelines for setting up the back table in the Operating Room during ISBCS. Additionally, no studies have been conducted on the time-saving effects of standardizing the dual table setup or its impact on workflow efficiency and patient safety.

This project aims to standardize the setup of the dual back table during ISBCS, examine the time-saving effects resulting from this standardization, improve turnaround time between cases, and enhance surgeons' efficiency during surgical cases.

The gap analysis conducted in January 2023 revealed non-standardized workflows and the absence of specific guidelines for the dual table setup at the Kaiser Permanente Eye Surgery Center in Rancho Cordova (KP ESC-RCO).

The project began by establishing a multidisciplinary team and champions to spearhead the project. A thorough process mapping of the ISBCS procedures, observing the workflows of surgeons, RN circulators, and scrub technicians, and critically mapping the techniques when setting up back tables during ISBCS. Additionally, the team conducted an OR room survey to establish a standardized setup for each room, aiming to improve efficiency. Moreover, the multidisciplinary team created an audit tool to observe current practices and gather pre-data from February 2023 to July 2023. The clinical champions audited the six surgeons who adopted the ISBCS at KP ESC-RCO over six months to collect baseline data on process and practice.

After six months of process and practice observation, the multidisciplinary committee developed guidelines and standardized the dual back table setup for the scrub technicians, conducted multiple training sessions and hands-on practice, created visual aids and laminated resources for the team, provided real-time peer-to-peer feedback by the clinical champions, and continuous audits for compliance and improvements of practice. The post-implementation data was collected from August 2023 to January 2024.

A baseline average case length of 46.5 minutes per case was collected from February 2023 to July 2023 as pre-data. The post-implementation of standardized dual table set-up for ISBCS shows an average case length of 44.30 minutes per case from August 2023 to January 2024. The average case reduction was 2.2 minutes per case, with no reported post-operative infections or adverse events. This allows the surgical team to improve their turnaround time between cases and enhance surgeons' efficiency during ISBCS.

In conclusion, the standardization of the "Dual Table Set-up" prevents cross-contamination between ISBCS, streamlines the surgical team's workflow, reduces turnaround time, and improves patient safety and outcomes.