Thinking Lean

Callaway, Natalia F.; Park, Joyce H.; Maya-Silva, Jacqueline; Leng, Theodore

doi:10.1097/iae.0000000000000712

Cited by 8 publications

(6 citation statements)

References 8 publications

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“…Such brief measurements could further improve clinical efficiency, which was previously slow, regarding new concepts for the use of decentralized OCT imaging. 25 …”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of a Novel Sparse Optical Coherence Tomography Device for Patient-Delivered Retina Home Monitoring

Maloca

Hasler

Barthelmes

et al. 2018

Trans. Vis. Sci. Tech.

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PurposeTo study a novel and fast optical coherence tomography (OCT) device for home-based monitoring in age-related macular degeneration (AMD) in a small sample yielding sparse OCT (spOCT) data and to compare the device to a commercially available reference device.MethodsIn this prospective study, both eyes of 31 participants with AMD were included. The subjects underwent scanning with an OCT prototype and a spectral-domain OCT to compare the accuracy of the central retinal thickness (CRT) measurements.ResultsSixty-two eyes in 31 participants (21 females and 10 males) were included. The mean age was 79.6 years (age range, 69–92 years). The mean difference in the CRT measurements between the devices was 4.52 μm (SD ± 20.0 μm; range, −65.6 to 41.5 μm). The inter- and intrarater reliability coefficients of the OCT prototype were both >0.95. The laser power delivered was <0.54 mW for spOCT and <1.4 mW for SDOCT. No adverse events were reported, and the visual acuity before and after the measurements was stable.ConclusionThis study demonstrated the safety and feasibility of this home-based OCT monitoring under real-life conditions, and it provided evidence for the potential clinical benefit of the device.Translational RelevanceThe newly developed spOCT is a valid and readily available retina scanner. It could be applied as a portable self-measuring OCT system. Its use may facilitate the sustainable monitoring of chronic retinal diseases by providing easily accessible and continuous retinal monitoring.

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“…Such brief measurements could further improve clinical efficiency, which was previously slow, regarding new concepts for the use of decentralized OCT imaging. 25 …”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of a Novel Sparse Optical Coherence Tomography Device for Patient-Delivered Retina Home Monitoring

Maloca

Hasler

Barthelmes

et al. 2018

Trans. Vis. Sci. Tech.

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“…Historically, eye examinations in hospital eye clinics have been fragmented, inefficient, and costly. 4 – 6 , 8 The binocular OCT prototype combines many routine tests into one single instrument, with the aim of improving the speed and efficiency of patient flow, in addition to providing reproducible and quantitative data for several aspects of the eye examination. Designed as an automated, patient-operated device, usability testing is indispensable to predict the likelihood of future successful implementation in eye clinics.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, the median time taken to complete the examination was 702 seconds (11.7 minutes) for participants with chronic eye disease and 638 seconds (10.6 minutes) for healthy controls. By comparison, Callaway et al 8 reported a mean clinic time of 28.8 minutes for patients to undergo technician work-up (including history-taking and visual acuity measurement), and acquisition of retinal OCT in the photography suite. In many real-world settings, mean diagnostic testing time is likely to greatly exceed this, particularly in public healthcare settings, which are often overburdened and under resourced.…”

Section: Discussionmentioning

confidence: 99%

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Human Factor and Usability Testing of a Binocular Optical Coherence Tomography System

Chopra

Mulholland

Dubis

et al. 2017

Trans. Vis. Sci. Tech.

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PurposeTo perform usability testing of a binocular optical coherence tomography (OCT) prototype to predict its function in a clinical setting, and to identify any potential user errors, especially in an elderly and visually impaired population.MethodsForty-five participants with chronic eye disease (mean age 62.7 years) and 15 healthy controls (mean age 53 years) underwent automated eye examination using the prototype. Examination included ‘whole-eye' OCT, ocular motility, visual acuity measurement, perimetry, and pupillometry. Interviews were conducted to assess the subjective appeal and ease of use for this cohort of first-time users.ResultsAll participants completed the full suite of tests. Eighty-one percent of the chronic eye disease group, and 79% of healthy controls, found the prototype easier to use than common technologies, such as smartphones. Overall, 86% described the device to be appealing for use in a clinical setting. There was no statistically significant difference in the total time taken to complete the examination between participants with chronic eye disease (median 702 seconds) and healthy volunteers (median 637 seconds) (P = 0.81).ConclusionOn their first use, elderly and visually impaired users completed the automated examination without assistance. Binocular OCT has the potential to perform a comprehensive eye examination in an automated manner, and thus improve the efficiency and quality of eye care.Translational RelevanceA usable binocular OCT system has been developed that can be administered in an automated manner. We have identified areas that would benefit from further development to guide the translation of this technology into clinical practice.

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“…This approach has also been used in outpatient retina clinics, shortening wait times by changing photography workflow, adjusting staffing, and optimizing scheduling. 4,15 In this study, we use a comprehensive quality improvement approach, based in part on the aforementioned Lean Six Sigma methodologies, to determine strategies for reducing total visit duration in an academic ophthalmology department. Total visit duration is defined as the time from the patient's scheduled appointment to when they check out of the clinic.…”

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confidence: 99%

Successful Interventions to Improve Efficiency and Reduce Patient Visit Duration in a Retina Practice

Lin

et al. 2021

Retina

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Purpose: To reduce the total clinic visit duration among retina providers in an academic ophthalmology department.Methods: All patient encounters across all providers in the department were analyzed to determine baseline clinic visit duration time, defined as the elapsed time between appointment time and checkout. To increase photography capacity, a major bottleneck identified through root cause analysis, four interventions were implemented: training ophthalmic technicians to perform fundus photography in addition to optical coherence tomographies, relocating photography equipment to be adjacent to examination rooms, procuring three additional Optos widefield retinal photography units, and shifting staff schedules to better align with that of the providers. These interventions were implemented in the clinics of two retina providers.Results: The average baseline visit duration for all patients across all providers was 87 minutes (19,550 patient visits). The previous average visit duration was 80 minutes for Provider 1 (557 patient visits) and 81 minutes for Provider 2 (1,246 patient visits). In the 4 weeks after interventions were implemented, the average visit duration decreased to 60 minutes for Provider 1 and 57 minutes for Provider 2.Conclusion: A systematic approach and a multidisciplinary team resulted in targeted, cost-effective interventions that reduced total visit durations.

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Thinking Lean

Abstract: Decentralized OCT represents the application of lean process concepts to improve vitreoretinal clinic efficiency. Decentralized OCT reduced both the total wait time and total time in clinic for return patients in a vitreoretinal clinic.

Cited by 8 publications

References 8 publications

Safety and Feasibility of a Novel Sparse Optical Coherence Tomography Device for Patient-Delivered Retina Home Monitoring

Safety and Feasibility of a Novel Sparse Optical Coherence Tomography Device for Patient-Delivered Retina Home Monitoring

Human Factor and Usability Testing of a Binocular Optical Coherence Tomography System

Successful Interventions to Improve Efficiency and Reduce Patient Visit Duration in a Retina Practice

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