Eyeworld Supplements

6 | SUPPLEMENT TO EYEWORLD | AUGUST 2020 Turning the Lights Back On Perform questionnaires and temperature checks before patients even enter the clinic. Source: Elizabeth Yeu, MD, screenshot from the 2020 ASCRS Virtual Annual Meeting our work family. We have a reduced staff, and some doc- tors have chosen to not return full time. Thus, we are trying our best to accommodate the patients who want to be seen. These are just a few pearls for reframing your clinic flow in the new age of social distancing. Pearl 1: Prepare patients for their visit. When we think about what our patients ex- perience and think about eye- care and elective medical care, they're nervous. When we queried our internal patients, a sample of 5,500 patients among different locations, 25–50% said they were not ready to come in for a visit. Of all elective surgery patients who had surgery put on hold but as of May 1 were cleared, two-thirds wanted to wait on rescheduling at that time. Contact and communicate with patients so they know ahead of time that things will (and must) look different. Set their expectations for what their experience will be like at their appointment. We created a video to help educate and prepare patients for what the exam will look like now and the safety measures that are being taken. Having these expectations expressed in a phone call, email, and letter is helpful. Patients need info about what they should bring to the office and when they should be arriving. Pearl 2: Reduce face-to-face time in the office. We need to shorten appointments and try to automate the process, whether in remote or virtual visits. We had tried to split up new patient evaluations, which can take upward of 3 hours, with the patient's health and safety in mind. Un- fortunately, this did not work out for most of our patients because it was more difficult to find transportation and support for two shorter visits than to come in for one longer visit. I think we can change the frequency of follow-up appointments, especially for stable examples like glaucoma and dry eye. We've increased our telehealth offerings, but are finding these, in many cases, difficult to manage. Our specialty of medicine is difficult to shift follow-up appointments to virtual visits, and we have not been able to expand this to follow-ups beyond routine POD 1 for cataract surgery and some routine dry eye and glauco- ma follow-up appointments. Surprisingly, post-surgical cat- aract patients have embraced virtual visits for the POD 1 appointment, and this has worked out well. There have been no undue surprises at their postop week 1 in-person visit. We adjusted our cataract surgery perioperative kit to include acetazolamide 250 mg dose in the recovery room and brimonidine 0.2% BID x1 to the operative eye. Pearl 3: Observe the 6-feet distancing rule. Distance equipment and chairs in the waiting room. Separate the check-in and check-out loca- tions (consider even having a satellite tent outside for check- in with automatic check-in freestanding stations). Ask that family and caregivers wait in the car to minimize bodies in the clinic. Pearl 4: Prevent COVID-19 spread. Wear face masks at all times and have all clinic members and staff members answer questionnaires. At our clinic all patients and staff are getting their temperature checked. Patients are instruct- ed to arrive no more than 10 minutes prior to their sched- uled appointment. With regard to surgery, we can consider PCR test- ing of all surgical patients. Avellino has a rapid PCR test where we can get results within 4–7 hours. My prac- tice is not doing antibody or PCR testing, but all patients are rinsing their mouth with a povidone-iodine solution, which SARS-CoV is extremely susceptible to. Lastly, we're considering doing some im- mediate sequential bilateral cataract surgery to meet the needs of patients who have not been able to be cared for, particularly as the demand increases. Pearl 5: Take care of your work family and promote goodwill. Clinic members are anxious as well and it may be continued from page 5

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