This is the profile of the efficient cataract surgeon. Hopefully you recognize him and not his evil twin, Dr. Dawdler, who before every case adjusts his gloves, straightens the drapes, considers which lens to put in, and fiddles with his chair and the table height. After surgery, Dr. Dawdler visits with the patient and the patient's family members, but only after texting and talking on his smartphone.

The efficient cataract surgeon does none of this. He is focused and deliberate, each step of the surgery leading him right to the next. His cases are well rehearsed and finely choreographed. There is no wasted motion, no extra or repeated steps, no idle chitchat, rarely any complications. He has his procedure time inside the eye down to 3 to 4 minutes, and patients — from registration desk to parking lot — are in the facility for no more than 2 hours. Based on our survey of more than 200 ophthalmic administrators, here's what the supremely efficient cataract surgeon looks like.

Habits worth having
He arrives on time (meaning before the scheduled start time) and is ready to go. He talks less and works more. Once he's in the OR, he stays in the OR until he's run through the schedule. Between patients, he helps with room turnover.

He waits until day's end to dictate (unless you have pre-printed op reports the doc can sign during room turnover) and to speak to patients — on the telephone, not in the PACU while the meter is running on expensive OR time.

He's not above pitching in. "Our surgeon helps out by gloving and gowning herself, assisting with pushing carts in and out of the surgery room and at times will even prep the eye if staff is busy with equipment," says Susie Armstrong, RN, administrator of the Topeka (Kans.) Surgery Center.

He doesn't routinely use retrobulbar blocks — it's topical anesthesia only, IV sedation if necessary to augment an overly anxious patient. More than three-fourths (75.9%) of the 216 facility managers we surveyed use topical anesthesia with drops; 65.7% use IV anesthesia, 44.4% use retrobulbar blocks; and 10.2% use topical anesthesia with a pledget.

He's supremely skilled, ambidextrous even, able to operate with his left or right hand depending on if the patient is OS or OD.

He rarely looks up from the microscope during the case. Your techs can load the lenses and make many of the phaco setting changes.

He works 2 rooms, the next case prepped and ready to go as soon as he's done with the current case. "We have a turnover time of 4 minutes and a time of 1 minute and 20 seconds from the time the surgeon stands up from 1 patient and sits down to work on the next patient," says Brian Moser, MBA-HCM, COT, assistant administrator of the HEA Surgery Center in Houston, Texas.

He is consistent, minimizing instruments and duplicating the procedure with every patient regardless of cataract type or condition.

He surrounds himself with a great team, letting the RN prep the patient and the scrub tech drape the patient and position the speculum while he's scrubbing his hands. "We have the same techs working with the physicians, which improves efficiency as they have the routine down to a fine art," says Emily Duncan, RN, BS, CASC, executive director of the Lakeland (Fla.) Surgical & Diagnostic Center. He encourages a spirit of teamwork, too. "Everyone looks for ways to improve the flow, like tearing tape ahead of time," adds another administrator. "Staff have set jobs they do, but everyone helps each other as needed."

Finally, if there's a break in the schedule, he eats lunch at the center — so, yes, be sure food is waiting for him when he's ready to eat.

What you can do
An efficient cataract surgeon is worth his weight in gold. But don't overlook the things you can do to keep cases moving on busy eye days.

Never keep a surgeon waiting for an instrument set. Are some of your surgeons so efficient that your sterile processors can't keep up with them? This might seem like a good problem to have, but it can have bad consequences: delayed cases, backed-up schedule and fuming surgeons because you don't have instrument sets ready.

Some solutions to consider: Invest in more instrument sets and phaco handpieces. Expensive, yes, but your surest bet to avoid long turnovers and flashing between cases (avoid flash sterilization, which should only be done in an emergency, never routinely). Plan your equipment needs around your busiest surgeon. If he can do 12 cases in a day, you should have that many trays and phaco handpieces to give him a sterile setup for each case, says Linda Winterer, RN, MS, CNOR, clinical coordinator of the Northwest Community Day Surgery Center in Arlington Heights, Ill. "We maintain a limited backup supply of eye instruments for our clear cornea trays, sterilized to replace those instruments that break and are unable to be repaired, so no tray is down and we have a full complement of 12," she adds.

Use an instrument processing company. "We have 30 full instrument sets that we use, so we just have to pull a set and we are ready to go," says Mr. Moser. "We have a special cart outside the room that the floater tech has the next case instruments on. As soon as the patient and dirty instruments are out of the room, the cart is wheeled in for a quick setup."

Finally, get your reprocessing tech some per diem help on busy days. They can take turns doing instrument and room turnovers.

• Pull each case in advance. Before leaving the center for the night, set up for the next day's cases (there should never be a reason for the nurse to leave the OR to track down supplies). Keep supplies for a surgery block in the room or right outside the room along with the trays so that as one case is done the next case is already lined up and ready to go. Custom packs greatly increase the speed of opening the case and turnover time. Keep backup supplies and instruments in the room.
• Do a thorough pre-op telephone questioning. This way, when the patient arrives, all he has to do is verify that you've transcribed the information correctly.
• Transport patients on stretcher chairs. For patients and staff alike, it's much safer and more convenient to transfer patients on stretcher chairs rather than transferring them from recliners to the OR chair and then back to recliners after surgery. Patients get in 1 bed, are connected to monitors on the eye cart and stay on it until discharge. More than three-fourths (76.7%) of the 216 facility managers we surveyed use stretcher chairs.
• Save time monitoring. Use limb clips instead of EKG chest patches to monitor an EKG reading in pre-op, intra-op and post-op. "This saves a lot of time, plus there are no patches to pull off the patients," says Mary Berkbigler, RN, BS, CNOR, administrator of the Tri-Lakes Surgery Center in Branson, Mo. Or, you can mount the cardiac monitors on the stretcher so they travel with patients throughout their stay. "It saves time transferring the monitor leads each time the patient enters a different clinical area for care," says JoAnne L. Looker, RN, CNOR, clinical director of the Winchester Eye Surgery Center in Winchester, Va.
• Don't give patient discharge instructions in recovery. Do you give patients post-op instructions in a cubicle while they're eating their snack and a family member is present, as more than half (53.7%) of those we surveyed do? You're slowing yourself down. Give all discharge instructions in pre-op so that when the patient gets to post-op, you can call the waiting room to alert the family member to bring the car around. "Our patients get post-op instructions initially on their pre-op testing day. They take home written instructions and then we review these again in post-op and hand them another copy of the instructions," says Gina Stancel, LHRM, CST, COA, administrator of the Surgicare Center in Fort Myers, Fla.
• Let patients stay in their street clothes in the OR. Of the 216 managers we surveyed, more than half (52.8%) let patients keep all their street clothes on while in the OR. About one-third (32.9%) let patients wear only pants, underwear and socks. And 14.4% make patients change entirely out of their street clothes.