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. 2020 Jun 25;5(1):e000426.
doi: 10.1136/bmjophth-2019-000426. eCollection 2020.

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

David P O'Brart  1   2 , Harry Roberts  3   2 , Khayam Naderi  3   2 , Jack Gormley  3
Affiliations

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

David P O'Brart et al. BMJ Open Ophthalmol. .

Abstract

Objective: To 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 analysis: Previously 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.

Results: Based 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.

Conclusion: The 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.

Keywords: lens and zonules; treatment surgery.

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Conflict of interest statement

Competing interests: DO’B holds non-commercial research grants with Alcon Inc and Rayner Ltd. He has undertaken consultancy work for Alcon Inc, Avedro Inc, Sooft Italia S.P.A. and Sparca Inc in the past 36 months. HR has undertaken consultancy work for Alcon Inc in the past 18 months.

Figures

Figure 1
Figure 1
Time and motion of ISBCS versus two conventional unilateral cataract surgery cases based on averaged figures for all 7 OR session studies. ISBCS, immediately sequential bilateral cataract surgery; OR, operating room.
See this image and copyright information in PMC

References

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