Aug 9, 2024
Apr 3, 2025
Written By Elizabeth Cifers
Part one of our three-part series on improving retina practice efficiency focused on the front desk. Now, we focus on the next step in the patient experience: work-up and testing.
There are many opportunities to create efficiencies for your retina practice in work-up and testing. These process adjustments are practical, and some might seem obvious. But even though we recognize how simple and effective they are, we may not have implemented them in our practices, making them worth repeating. Every strike against efficiency is a blow to profit. If you know how to improve your clinical operations, today is the day to make it happen!
Some retina practices keep flexible schedules due to the emergent nature of many retina conditions. The flexibility can lead patients to incorrectly believe that the schedule is arbitrary, resulting in inefficiencies if protocols aren’t followed.
Suppose work-up techs do not have a protocol to follow when taking patients to the work-up rooms. In that case, the tech may be incentivized to “cherry-pick” “quick and easy” patients, moving them to the front of the line and leaving more involved workup cases (such as new or annual patients) to other techs. In addition to creating inefficiencies, this skews the performance metrics that measure them.
If patients are seen whenever they arrive, without regard to their scheduled appointment time, they are more likely to disregard the schedule and come whenever they like. Now, the waiting room is full of people who came at their appointed time and those who popped in three hours early.
Both behaviors will quickly throw a thoughtful, efficient schedule out the window. While maintaining flexibility to allow for emergencies, ensuring patient work-up follows the order of appointments is imperative for maintaining operational efficiency.
In the name of proactive preparation, a tech may enter patient information before bringing the patient to the work-up room. However, this process introduces inefficiencies.
First, the work-up tech adds more time to the appointment by taking additional steps, such as walking to the work-up room, returning to get the patient, and returning to the room with the patient. Second, the tech may have to re-enter the information because it was entered incorrectly without the ability to confirm with the patient. Finally, the tech may not ask the patient to verify the information, which can result in inaccuracies that produce a snowball of inefficiencies later.
It's better to do everything at once—ideally, techs should enter patient information while the patient is in the room with them so they can make one trip and confirm as they go.
While the most efficient data entry is directly into the electronic format, some still prefer and opt to write on paper. Unfortunately, old habits need to change for work-up techs with this preference. We all know why paper is inefficient—to write and then type the same information takes double the time and effort. If you wish to improve overall efficiency at your retina practice, kick this outdated way of working to the curb.
*Exception: Some physicians may wish to keep certain information on a “fee slip” or “runner tag” that follows the patient through the clinic—for example, visual acuity (VA), intraocular pressure (IOP), or any complaints listed, or changes noted by the patient—a “quick and dirty” look for the physician. This use of paper notes gets a pass.
The work-up tech should instill the drops if a patient needs dilation for a diagnostic test or exam. Dilation can take some time. The work-up tech should start the process rather than wait for the photographer to sit and wait for the patient to dilate. By the time the photographer is ready for the patient, if the work-up tech instilled the drops, the patient may be dilated (or mostly) dilated.
The recommendation for testing efficiency is like the recommendation for the timing of data entry. Technicians should wait until the patient is in the room before pulling them up in the machine. Doing it all at once saves steps, allows for information confirmation (such as date of birth to ensure the patient being tested is the correct patient), and prevents the compound effect of inefficiencies.
Patient workup and testing provide ample opportunities to improve your retina practice efficiency. Sticking to the schedule, becoming more efficient with patient data entry, and having the workup technician handle any dilation that needs to occur before a diagnostic test are process adjustments that may be small but add up to significant cost savings over time.
After decades of observing and optimizing clinical operations—including 13 years at a retina clinic and a position at a leading eye care consulting firm—retina practice consultant Elizabeth Cifers has the specific insight into the unique challenges faced by the retina specialty to transform the flow and efficiency of your practice. If you’d like to explore your options or know your retina practice could benefit from clinical operations consulting, book a free consultation with Elizabeth here.
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