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Park SS, Vij R, Wu J, Zarrin B, Moon JY, Oliveira J, Schultz JS, Shrivastava A. A Systematic Analysis of the Impact of an Ambulatory Ophthalmology Urgent Care Clinic. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2022. [DOI: 10.1055/s-0041-1741464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Importance A same-day ophthalmic urgent care clinic can provide efficient eye care, a rich educational environment, and can improve patient experience.
Objective The aim of this study was to systematically evaluate volume, financial impact, care metrics, and the breadth of pathology of urgent new patient encounters based on their site of initial presentation.
Design, Setting, and Participants A retrospective analysis was performed on consecutive urgent new patient evaluations in our same-day triage clinic at the Henkind Eye Institute at Montefiore Medical Center between February 2019 and January 2020. The cohort of patients who presented directly to this urgent care clinic were referred to as the “TRIAGE” group. Patients who initially presented to an emergency department (ED), and were subsequently referred to our triage clinic, are referred to as the “ED + TRIAGE” group.
Main Outcomes and Measures Visits were evaluated on a variety of metrics, including diagnosis, duration, charge, cost, and revenue. Furthermore, return to the ED or inpatient admission was documented.
Results Of 3,482 visits analyzed, 2,538 (72.9%) were in the “TRIAGE” group. Common presenting diagnoses were ocular surface disease (n = 486, 19.1%), trauma (n = 342, 13.5%; most commonly surface abrasion n = 195, 7.7%), and infectious conjunctivitis (n = 304, 12.0%). Patients in the “TRIAGE” group, on average, were seen 184.6% faster (158.2 vs. 450.2 minutes) than patients in the “ED + TRIAGE” group (p < 0.001). The “ED + TRIAGE” group were furthermore found to generate 442.1% higher charges ($870.20 vs. 4717.70) and were associated with 175.1% higher cost ($908.80 vs. 330.40) per patient. The hospital was found to save money when noncommercially insured patients with ophthalmic complaints presented to the triage clinic instead of the ED. Patients seen in the triage clinic had a low rate of readmission to the ED (n = 42, 1.2%).
Conclusions and Relevance A same-day ophthalmology triage clinic provides efficient care, while providing a rich learning environment for residents. Less wait time with direct access to subspecialist care can help improve quality, outcome, and satisfaction metrics.
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Affiliation(s)
- Sally S.E. Park
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Rohin Vij
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jeff Wu
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Bryan Zarrin
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Jee-Young Moon
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jason Oliveira
- Department of Financial Planning and Analysis, Montefiore Health System, Tarrytown, New York
| | - Jeffrey S. Schultz
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Anurag Shrivastava
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
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Tsou BC, Vongsachang H, Purt B, Srikumaran D, Justin GA, Woreta FA. Cataract Surgery Numbers in U.S. Ophthalmology Residency Programs: An ACGME Case Log Analysis. Ophthalmic Epidemiol 2021; 29:688-695. [PMID: 34913813 DOI: 10.1080/09286586.2021.2015395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe and assess the cataract experience of ophthalmology residents throughout the United States (U.S.). METHODS Cataract procedures logged by graduating ophthalmology residents nationwide and published by the Accreditation Council for Graduate Medical Education (ACGME) from 2009 to 2020 were analyzed using linear regression on log-transformed response variables with robust variance. RESULTS As primary surgeon, average numbers logged for phacoemulsification increased yearly by an average of 4.1% prior to 2019 and then decreased by 22.1% in 2019 for an overall average yearly increase of 2.9% (95% CI: 0.5, 5.4%, p = .03), non-phacoemulsification extracapsular extraction decreased yearly by an average of 4.6% (95% CI: -7.7, -1.5%, p = .01), other cataract/intraocular lens surgeries decreased yearly by an average of 8.4% (95% CI: -10.1, -6.6%, p < .001), anterior vitrectomies decreased yearly by an average of 12.5% (95% CI: -14.9, -10.1%, p < .001), and laser capsulotomies increased yearly by an average of 6.0% prior to 2019 and then decreased by 3.0% for an overall average yearly increase of 5.3% (95% CI: 4.5, 6.2%, p < .001). As assistant, average numbers logged in all ACGME minimum categories showed decreasing trends. CONCLUSIONS Over the last decade, the average numbers of phacoemulsification and laser capsulotomies logged by residents as primary surgeon increased while other ACGME cataract minimum procedures decreased. Surgical volume in 2019-20 was lower due to the coronavirus disease-19 pandemic but higher than from 2009 to 2013.
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Affiliation(s)
- Brittany C Tsou
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hursuong Vongsachang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Boonkit Purt
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Grant A Justin
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Zale AD, Song CI, Zhou A, Lai J, Jang M, Lipsett PA, Desai SV, Hanyok LA, Bienstock JL. A Qualitative Study of the Barriers and Benefits to Resident Education in Ambulatory Surgical Centers. JOURNAL OF SURGICAL EDUCATION 2021; 78:1825-1837. [PMID: 34092534 DOI: 10.1016/j.jsurg.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/03/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE As Ambulatory Surgical Centers (ASCs) become more common in academic medical centers, large hospital systems must determine how to shift resident education from inpatient to outpatient surgical centers. This study aims to define stakeholders' views regarding the integration of surgical residents into ASCs. DESIGN Long-form interviews lasting 30 to 60 minutes were conducted. Interviews were hand-transcribed and analyzed by qualitative analysis to determine benefits of learning in ASCs for residents, challenges that arise from integrating residents, and recommendations to improve resident incorporation. SETTING Interviews were conducted using a video conferencing platform. PARTICIPANTS Residency program directors, attending surgeons, graduate medical learners, and a nursing manager were interviewed. Twenty-one total interviews were conducted, representing ten different departments. RESULTS Stakeholders agreed that residents benefit from being placed in ASCs because the fast, surgical pace allows the residents to engage in more cases. However, different stakeholders highlighted different challenges, all centered around the notion of inter-stakeholder conflict due to conflicting priorities among residents, attending physicians, and administration. Likewise, recommendations differed by stakeholder group-faculty members sought more defined learning objectives and enhanced communication, whereas residents desired that ambulatory surgical time be more structured. CONCLUSIONS Despite the pressures of rapid case turnover, stakeholders agreed that there are many benefits to resident education in ASCs. Findings related to challenges and recommendations support the need to strengthen communication between stakeholder groups and better plan for resident integration into ASCs.
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Affiliation(s)
- Andrew D Zale
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | | - Ashley Zhou
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan Lai
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Minyoung Jang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela A Lipsett
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanjay V Desai
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura A Hanyok
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Singman EL, Smith K, Mehta R, Boland MV, Srikumaran D, Frick K, Young L, Locco G, Tian J, Kowalewski C, McDonnell P. Cost and Visit Duration of Same-Day Access at an Academic Ophthalmology Department vs Emergency Department. JAMA Ophthalmol 2020; 137:729-735. [PMID: 31021382 DOI: 10.1001/jamaophthalmol.2019.0864] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Convenient outpatient access for ophthalmology patients seeking urgent care could offer savings compared with an emergency department (ED) visit. Objective To evaluate the costs and visit durations of same-day access (SDA) in an ophthalmology department at an academic medical center vs ED care. Design, Setting, and Participants This single-center study was a retrospective quality improvement analysis of an institutional electronic medical record system at the Wilmer Eye Institute clinics and the Johns Hopkins Hospital ED. On June 1, 2015, the Wilmer Eye Institute and Johns Hopkins Hospital initiated an official policy of providing SDA to patients calling for appointments (ie, the same-day project). All ophthalmology clinic locations created same-day appointment slots for at least 1 practitioner. In recognition of seasonal variations in patient visit volumes, the 10 months before implementation (August 1, 2014, to May 31, 2015) were compared with complementary periods in 2015 to 2016 and 2016 to 2017. Main Outcomes and Measures The study tabulated encounters, charges, and visit length for outpatients seen on the same day or by previously scheduled appointments. For the ED patients, volume, diagnoses, charges, and length of stay data were collected. The numbers of SDA patients who indicated urgency were tabulated. Results The number of SDA patients increased from 22 781 to 26 579 for the first year after SDA implementation. The mean charge was $258 (95% CI, $250-$266; median, $184; interquartile range [IQR], $175-$320), and the mean clinic transit time was 1.55 hours (95% CI, 1.54-1.57 hours; median, 1.28 hours). For patients seeking eye care in the ED, the mean professional fee was $401 (95% CI, $390-$411; median, $360; IQR, $255-$500), the mean (SD) total hospital charge was $1040 ($999) (95% CI, $729-$1079; median, $1002; IQR, $334-$1429), and the mean length of stay was 7.30 hours (95% CI, 7.01-7.57 hours; median, 7.20 hours). The top 4 ophthalmic diagnoses for ED patients were conjunctivitis, cornea abrasion, iritis, and visual loss, which were unchanged after SDA implementation. In calendar year 2017, a total of 4062 SDA patients reported urgency; their estimated savings in charges compared with an ED visit were $580 866 in professional fees and $3 176 484 in hospital charges. Conclusions and Relevance Same-day access appears to be less expensive and to require less time in the health care system than a visit to the ED for an ophthalmic diagnosis. Substantial savings in time and money might be achieved if urgent eye care is delivered in the clinic rather than the ED.
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Affiliation(s)
- Eric L Singman
- Wilmer General Eye Services, The Johns Hopkins Hospital, Baltimore, Maryland.,Wilmer Eye Institute, Baltimore, Maryland
| | - Kerry Smith
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Radhika Mehta
- Administrations Department, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Michael V Boland
- Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Divya Srikumaran
- Wilmer Eye Institute, Baltimore, Maryland.,Wilmer Eye Institute at Odenton, Odenton, Maryland
| | - Kevin Frick
- Department of Health Policy and Management, Johns Hopkins Carey Business School, Baltimore, Maryland
| | | | - Gina Locco
- Ophthalmology Registration, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jing Tian
- Biostatistics Consulting Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Affiliation(s)
- Sean P Donahue
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul Sternberg
- Vanderbilt Eye Institute, Vanderbilt Medical Group, Vanderbilt School of Medicine, Nashville, Tennessee
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Singman EL, Srikumaran D, Green L, Tian J, McDonnell P. Supervision and autonomy of ophthalmology residents in the outpatient Clinic in the United States: a survey of ACGME-accredited programs. BMC MEDICAL EDUCATION 2017; 17:105. [PMID: 28651531 PMCID: PMC5485577 DOI: 10.1186/s12909-017-0941-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 06/13/2017] [Indexed: 06/09/2023]
Abstract
BACKGROUND The development and demonstration of incremental trainee autonomy is required by the ACGME. However, there is scant published research concerning autonomy of ophthalmology residents in the outpatient clinic setting. This study explored the landscape of resident ophthalmology outpatient clinics in the United States. METHODS A link to an online survey using the QualtricsTM platform was emailed to the program directors of all 115 ACGME-accredited ophthalmology programs in the United States. Survey questions explored whether resident training programs hosted a continuity clinic where residents would see their own patients, and if so, the degree of faculty supervision provided therein. Metrics such as size of the resident program, number of faculty and clinic setting were also recorded. Correlations between the degree of faculty supervision and other metrics were explored. RESULTS The response rate was 94%; 69% of respondents indicated that their trainees hosted continuity clinics. Of those programs, 30% required a faculty member to see each patient treated by a resident, while 42% expected the faculty member to at least discuss (if not see) each patient. All programs expected some degree of faculty interaction based upon circumstances such as the level of training of the resident or complexity of the clinical situation. 67% of programs that tracked the contribution of the clinic to resident surgical caseloads reported that these clinics provided more than half of the resident surgical volumes. More ¾ of resident clinics were located in urban settings. The degree of faculty supervision did not correlate to any of the other metrics evaluated. CONCLUSIONS The majority of ophthalmology resident training programs in the United States host a continuity clinic located in an urban environment where residents follow their own patients. Furthermore, most of these clinics require supervising faculty to review both the patients seen and the medical documentation created by the resident encounters. The different degrees of faculty supervision outlined by this survey might provide a useful guide presuming they can be correlated with validated metrics of educational quality. Finally, this study could provide an adjunctive resource to current international efforts to standardize ophthalmic residency education.
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Affiliation(s)
- Eric L. Singman
- Wilmer Eye Institute General Eye Services Clinic, @ Johns Hopkins Hospital, Wilmer B-29, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Divya Srikumaran
- Wilmer Eye Institute General Eye Services Clinic, @ Johns Hopkins Hospital, Wilmer B-29, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Laura Green
- Ophthalmology Residency Program Director, Lifebridge Health Krieger Eye Institute, 2411 W. Belvedere Ave, Baltimore, MD 21215 USA
| | - Jing Tian
- Biostatistics Consulting Center, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Room 3148, Baltimore, MD 21287 USA
| | - Peter McDonnell
- Wilmer Eye Institute, @ Johns Hopkins Hospital, Maumenee 727, 600 N. Wolfe St, Baltimore, MD 21287 USA
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