Jason P. Brinton, MD features prominently in an article in the January 5, 2022 issue of the prestigious Ocular Surgery News (OSN) regarding the growing movement toward office-based surgery for refractive cataract patients.
The publication, celebrating its 40th anniversary in 2022, is part of the SLACK Inc. family of publications, a leading provider of healthcare news, education and management services worldwide. Dr. Brinton serves as a member of Healio’s/OSN’s refractive surgery editorial board.
The Jan. 5 article is one of the latest of many OSN articles and editorials on the topic of office-based surgery. (The full text of the article is available at OSN’s partner website, Healio.com.) In this article, Dr. Brinton and other top doctors in ocular surgery discuss the ways patients and practitioners can benefit from moving refractive cataract surgery out of the traditional hospital or ambulatory surgical center (ASC) setting and into office-based surgery (OBS).
A 2016 study published in Ophthalmology looked at more than 13,000 elective office-based eye surgery patients. Researchers found that OBS patients achieved positive visual outcomes and low adverse event rates, similar to what they would experience at hospitals and ASCs.
Dr. Brinton tells Ocular Surgery News, “In the office surgery setting, you can focus on meeting and exceeding proven ophthalmic patient safety standards rather than diversions such as staff drills on how to bag and evacuate an intubated general anesthesia patient during a fire.”
The focus on patient safety begins with how the issue of anesthesia is addressed in an OBS versus an ASC, Dr. Brinton says: “As practitioners, we seek to provide the optimal amount of sedation, and too much can be just as concerning, if not more so, than too little. In a hospital/ASC setting, with an IV in place and CRNA in the room, patients are more likely to get sedative medications that are not needed. In office-based surgery, out of necessity, the team learns to be adept at providing a relaxing environment with music, hand-holding, and conversing with the patient – what we call vocal local.”
Unlike a doctor using a hospital or surgical center’s suite and equipment, the owner-surgeon of an office-based eye surgery center has control over important variables that benefit the quality of care.
For example, an OBS facilitates more consistent and greater cooperation between the surgeon and the clinical/surgical staff. That team is selected and trained according to the owner’s practice, and each knows the surgeons’ preferences and patients’ concerns.
Additionally, the owner-surgeon exercises control over what, when, and from whom to purchase, streamlining inventory management that, could otherwise get tied up in bureaucratic red tape in a hospital setting. This way, OBS owners can operate more efficiently and potentially more affordably, without having to settle for one-size-fits-all, system-wide equipment and supply purchases.
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Patients are more at ease in an OBS suite than in a hospital or ASC setting for a variety of reasons. Chief among them is the warmth of the environment.
There is no sea of cold, searing-white walls or overburdened staff juggling cases that range from your cataract procedure to a cardiac stent. An office-based surgery center involves a more personal setting with a more predictable staff.
Better yet, an ocular surgery patient won’t suffer the distraction of incoming emergencies unrelated to eye care. Dr. Brinton says one of his refractive cataract patients witnessed the disparity between the ASC environment and OBS firsthand as Brinton transitioned from an ASC to his own practice in February 2015.
“As the previous patient was rolled out of the OR, he had a bandage around his head and neck area and made an audible moaning-type sound,” Dr. Brinton tells OSN. “Our first patient, who was waiting to go back to surgery, noticed this. It was upsetting and anxiety-provoking.”
Office-based surgery improves the patient experience by removing negative interactions. When Brinton’s patient came to his office-based center for his second surgery two weeks later, the visit was a study in contrast.
From OSN: “In the end, my patient had two entirely different surgeries, at least in his view. The first one was like having major surgery; in the second, his experience was comparable to what he heard from his friend who had LASIK in our office and referred him to our practice.”
It is worth noting as well that ocular OBS teams are generally more engaged with a smaller number of patients than ASC staff and are focused solely on eye surgery and ophthalmic clinic duties. This improves the performance of surgical and clinical teams and eases stress for both patients and staff.
You’ve heard the expression: location, location, location. Even in a mobile society, accessible care close to home is a key component of providing quality care.
In general, there is greater location flexibility for the owner of an office-based surgical practice than at a hospital or ambulatory surgery center. A suite dedicated solely to eye surgery under one doctor (or maybe just a few) requires a smaller supporting staff, a narrower variety of diagnostic and surgical machines, and a smaller physical footprint. Without those resource-eating needs, an OBS owner can more easily open their OBS in a pre-existing structure that is close to the community the owner desires to serve. Patients don’t have to commute to far-away places to receive quality surgical care.
The surgeon also benefits from a single, stable location: Rather than zip from one hospital or ASC to another – often waiting for a suite to open up – an OBS owner has a familiar home base where the surgical suite is always available when needed. This also contributes to better work-life balance for the entire team … and that can’t hurt either!
How Brinton Vision Keeps You Safe in an OBS Setting
Dr. Brinton contends that a large part of patient safety lies not just in the skill of the surgeon and the teamwork of the supporting staff but, it also relies on ensuring that an office-based surgery is appropriate for the patient.
“This discussion is not about sick patients,” he tells Ocular Surgery News. “It’s about whether younger and healthier patients having refractive lens exchange, refractive cataract and even some retina procedures now can be better served in an office surgery setting as opposed to the traditional ASC/hospital setting. In many cases, I believe OBS can be both more appropriate and also safer.”
Brinton Vision is proud to be the first refractive cataract surgery provider in the United States to transition from an ambulatory surgery center to his office-based surgery center. The practice also offers more vision correction solutions to our patients than any other LASIK eye surgery center in the St. Louis area. If you have questions about refractive eye surgery, feel free to call 314.375.2020 or book your Brinton Vision Ocular Analysis on our website at BrintonVision.com/schedule.