Same-Day Exam and Surgery: Observations and Advice

I co-manage a lot of patients with optometrists which presents a great opportunity to increase surgical volume. Travel time is a real consideration for patients and doctors and I realized that I needed to ease the distance burden for those who live far away from my Birmingham, Alabama practice. Typically, surgical treatments begin with an office visit for an examination, then another day for a scheduled procedure. Two roundtrips for medical treatment is enough to make some people balk. While it was not exactly a stroke of genius to try combining the two into a one-day event, it has turned out to be a great benefit to my patients, my associates, and my practice.

The Pathologies of Time and Distance

Alabama is a big state with extensive rural and agricultural areas in addition to cities like Birmingham. People who live farther away from population centers may have to travel for hours to access advanced healthcare services. For most, this is just an inconvenience, but for some, even the prospect of a 30-minute trip into “the big city” is daunting enough to put them off, even in serious cases where vision may be at stake. To reach them, you must remove as many barriers to surgery as possible, and this is where same-day surgery really helps.

Having to make the trip once instead of twice became a sufficient incentive to convince reluctant patients to get it done. It became easier for the referring doctors as well, who now promote the one-visit concept to encourage and accommodate these sorts of patients. Once the idea took off, it became an important service in my practice, both for patient care and the bottom line.

Results & Considerations

I have been doing same-day exam and surgery for more than 12 years now, and the patient response has been great from the start. They rave about the convenience, and once they agree to the one-day approach, they tend to get more interested in their recovery plan and the care options they can obtain at the larger, better-equipped practices that are more common near population centers.

A wide range of procedures can be good candidates for same-day scheduling. The only time to avoid it is when you do not have the necessary lenses or equipment on hand. With iOR’s asset and inventory management system, you should always have a consignment of lenses in stock, so unless the lenses are special order, same-day cataract surgery presents few problems.

LASIK surgery can also be done the same day as the exam, unless you need to evaluate the patient while dilated. If you use an iris-recognition system, it may not recognize the patient’s dilated pupil. These patients will need two visits, so their eyes can recover from dilation before surgery. For many others, though, laser vision correction and examination can be a seamless one-day event.

Same-Day And Office-Based Surgeries

For more than a decade, I have successfully cared for thousands of patients using same-day surgery. The health outcomes are no different than an exam and surgery scheduled for different days — if anything, patients do benefit from the reduced hassle and cost of not having to take more time off from work or arrange transportation to and from a second procedure.

About three years ago, I started doing cataract surgery in my iOR suite and quickly saw how it dovetails incredibly well with same-day surgery. You do not have to shuttle between facilities, and neither does the patient. Eliminating the time, expense and risk of needless transportation is not just a convenience, it is a professional obligation whenever possible. Incorporating an office-based surgery suite compounds the efficiencies of same-day surgery, and the two are a natural pair.

Getting Started

For doctors considering adding same-day exam and surgery or office-based surgery to their offerings, I encourage you to start out slowly. To ensure everybody is on board with the new system, thorough training is a must. Your staff will need some time to get up to speed, so be patient. Before long, the advantages will make themselves apparent. As you get comfortable with the new protocols, you will get faster and reach a point where you can do more, or even add another layer of service.

If you are just starting out with office-based surgery, it may be easier to stick with traditional two-day exam and surgery for patients who are more comfortable doing it that way. Once you have dipped your toe into the pool, so to speak, and are comfortable with office-based surgery, you can decide to try doing same-day surgery. Start out slow and easy, pick uncomplicated procedures and get comfortable. The skills and speed will follow.

Ultimately, as a physician, I focus on the patient experience. The reason office-based cataract/MIGS surgery and same-day surgery fit together so nicely is that the combination offers my patients a better experience, with less time and energy wasted. This turns out to be very appealing not only for the patient but for the referring doctor and the surgeon, too.