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Avni Badami, Frank Vavrek, Pamela Rosenkranz, Susannah Rowe, Manju Subramanian; Phone Screening for Preoperative Medical Clearance for Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2234. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Cataract surgery is the most commonly performed procedure among developednations and as the prevalence of cataract surgery increases, so do the resources and time spenton pre-operative medical clearance. The principle aim of this study was to retrospectivelyreview an initiative consisting of obtaining a history and giving pre-operative instructions overthe telephone to determine if a phone visit could safely substitute for an in person visit forpatients undergoing cataract surgery.
After communication with Joint Commission, a phone visit initiative wasimplemented on October 1, 2015 inclusive of patients aged 18 or greater undergoing cataractsurgery with monitored anesthesia care who are able to lie flat on a bed. With IRB approval,this retrospective case series reviewed subjects undergoing eye surgery from October 1, 2014to September 30, 2017. The primary outcome measured was medical adverse events includingmortality, cancellation rates due to medical conditions, and admissions following surgery.Secondary outcome measures included no show rates for surgery and access to pre procedureappointments.
In the study period, 2084 patients underwent in person visits (October 2014 throughSeptember 2015) prior to initiation of the phone screening protocol. Starting on October 2015,2010 subjects underwent in person visits (for all eye surgery types), and 2071 underwent phonescreenings (cataract surgery only). During the 3 year study period, there were no mortalitieswithin a 24 hour period following surgery and no unplanned admissions. There were a total of89 same day cancellations with no significant difference between in person and phonescreenings (p= 0.72). No show rates for phone visits (13.4%) compared to in person visits(22.8%) were significantly lower (p=0.0001) and a review of available slots in a 3 month perioddemonstrated that access to phone visits are 3 times better than in person visits.
This study demonstrates that over a 2-year period, clearances by phone forpatients undergoing cataract surgery did not lead to an increase in unplanned admissions,mortality, or cancellations. Furthermore, the increased availability of phone visits allows forincreased access, savings in time and other allocated resources such as space and personnel,without increasing harm for patients. The results of this study may allow for similar protocols tobe safely implemented at other large, high volume institutions.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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