Economic modelling of immediately sequential bilateral cataract surgery (ISBCS) in the National Health Service based on possible improvements in surgical efficiency

Abstract

ObjectiveTo test a hypothesis that operating room (OR) productivity in the National Health Service (NHS) can be improved with the introduction of immediately sequential bilateral cataract surgery (ISBCS).Methods and analysisPreviously published time and motion data of 140 unilateral cataract surgeries conducted at five different NHS locations were reanalysed to construct a hypothetical model where only ISBCS (±one unilateral case) were conducted while maintaining time durations of all key tasks previously studied. Possible time efficiency savings were calculated for the ISBCS model and percentage increases in numbers of eyes operated per 4-hour theatre session calculated. Gains in efficiency were correlated with factors from the baseline data to predict which settings could improve efficiency most by undertaking ISBCS.ResultsBased on remodelling our time and motion study (TMS) data as hypothetical ISBCS cases, we could expect a mean 16% reduction (range 9.8%–17.8%) in the time taken for two cataract operations, translating into a mean 54% improvement (range 38%–67%) in number of cases currently performed per list and an 18% improvement (range 9%–28%) even if the number of unilateral cases per list had been fully maximised. An average number of four ISBCS cases per list (range 3–6) were required to achieve sufficient time savings to allow an extra unilateral surgery to be conducted.ConclusionThe introduction of routine ISBCS has the potential to improve the productivity of cataract surgery within the NHS, with efficiencies being possible in both high-volume and low-volume surgical models.

Acceptability of immediate sequential bilateral cataract surgery (ISBCS) in a public health care setting before and after COVID-19: a prospective patient questionnaire survey

“…This quite high percentage is encouraging, suggesting the limited routine implementation of ISBCS in the National Health Service (NHS) is possible, with all its associated cost savings [15][16][17] and potential for improving surgical productivity. 18 Under a quarter agreed/strongly agreed that they had any familiarity with the concept of ISBCS (table 2). Although, there were no strong correlations between this factor and the other ISBCS questions, given the reported lack of knowledge of ISBCS, patient education in this area is required and further studies needed to see if by informing patients of the nature of ISBCS and the very small risk of bilateral sight-threatening complications, acceptance well above 50% can be achieved.…”

“…16 17 By reducing patient operating room (OR) transfer times and OR preparation times, ISBCS has the potential to increase efficiency, allowing more CS cases to undergo surgery within a given time. 18 Surgeon opinions with regards to ISBCS have been published, [19][20][21] but there is no information regarding patient attitudes/concerns. To address this discrepancy, we designed this study.…”

“… 16 17 By reducing patient operating room (OR) transfer times and OR preparation times, ISBCS has the potential to increase efficiency, allowing more CS cases to undergo surgery within a given time. 18 …”

Bilateral Same-Day Cataract Surgery: An Idea Whose Time Has Come #COVID-19

“…2 Hospitals achieve higher productivity and cost savings of more than 30% when performing ISBCS instead of delayed sequential bilateral cataracts surgery (DSBCS). 3 , 4 , 5 The new normal of the COVID-19 era requires extra spacing, cleaning, and time between patients, resulting in increased costs. When considering the additional patient costs for travel, family and caregiver time, and absence from work with the extra postoperative visits and recovery requirements of DSBCS, the cost efficiency is even greater with ISBCS.…”

Attitudes to cataract surgery during the COVID-19 pandemic: a patient survey

“…47.3% and 37.2% were concerned about contagion in the hospital or on their journey to/from hospital, respectively. 26.6% were more positive towards immediate sequential bilateral cataract surgery (ISBCS), which might help surgical throughput [ 5 ]. There was a positive correlation between worsening QOL and willingness to attend ( r = 0.236, p = 0.001).…”