Abstract
Purpose :
Cataract surgery is the most commonly performed procedure among developed
nations and as the prevalence of cataract surgery increases, so do the resources and time spent
on pre-operative medical clearance. The principle aim of this study was to retrospectively
review an initiative consisting of obtaining a history and giving pre-operative instructions over
the telephone to determine if a phone visit could safely substitute for an in person visit for
patients undergoing cataract surgery.
Methods :
After communication with Joint Commission, a phone visit initiative was
implemented on October 1, 2015 inclusive of patients aged 18 or greater undergoing cataract
surgery 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, 2014
to September 30, 2017. The primary outcome measured was medical adverse events including
mortality, cancellation rates due to medical conditions, and admissions following surgery.
Secondary outcome measures included no show rates for surgery and access to pre procedure
appointments.
Results :
In the study period, 2084 patients underwent in person visits (October 2014 through
September 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 phone
screenings (cataract surgery only). During the 3 year study period, there were no mortalities
within a 24 hour period following surgery and no unplanned admissions. There were a total of
89 same day cancellations with no significant difference between in person and phone
screenings (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 period
demonstrated that access to phone visits are 3 times better than in person visits.
Conclusions :
This study demonstrates that over a 2-year period, clearances by phone for
patients undergoing cataract surgery did not lead to an increase in unplanned admissions,
mortality, or cancellations. Furthermore, the increased availability of phone visits allows for
increased 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 to
be 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.