Reducing Patient Waiting Time for Cataract Surgery

Overview

The purpose of this study is to examine how coordination between hospital departments affects patient flow between the free ward (B1), paid ward (C1) and the operating theatre (OT) for cataract surgeries at a tertiary eye care hospital. This will be an Interventional study using both quantitative and qualitative methods conducted at Tejas Eye Hospital. Patients aged 40-85 years, scheduled for cataract surgery during the study period will be included. Two trained investigators would observe the process and collect the data in structured format from ward admission to transfer into the operating theatre. Every participant would be observed from the ward on the day of his schedule surgery till his surgery is over in operation theatre. Demographic details and personal characteristics of every participant would be recorded in data collection form. In this pathway, timings, events, errors, deviations would be recorded at different spots between ward and operation theatre in first phase of study. Data would be collected from total 364 participants selected using stratified sampling technique. The data will be analyzed using MS excel and EpInfo. Summary statistics would be calculated for different variables and listing of various events and errors would be done. Using the above analysis various delays, communication gaps and different deviation would be identified. A dissemination meeting would be organized with all involved in above processes and findings would be shared in detail. Specific intervention would be decided for execution in the second phase of this study. In second phase, predetermined interventions from analysis of first phase would be implemented and similar data collection would be carried out to see the impact of interventions. Data collection would be done from the phase one sample size and comparison would be carried out for important variables like delays to establish the final outcome of the study. Similarly reduction in frequencies of errors and deviations would also be calculated.

Hospitals worldwide face persistent challenges in achieving effective coordination between clinical departments. According to the World Health Organization, nearly 50% of medical errors are associated with poor communication and coordination among healthcare teams. Studies from the United States indicate that up to 70% of healthcare professionals identify communication failures as a major contributor to adverse events, including wrong patient selection, incorrect medication use, miscommunication of clinical status, and inaccurate reporting of patient symptoms. Global surveys further suggest that only about one-third of healthcare professionals perceive interdepartmental coordination in their organizations as effective. The delivery of hospital care involves complex workflows that require timely coordination between multiple units. Breakdowns in communication and process alignment can lead to delays, inefficiencies, and increased risk of errors, particularly in high-volume surgical settings. Despite its importance, achieving consistent coordination remains a challenge at global, national, and institutional levels. In India, the healthcare system is undergoing rapid transformation with increased emphasis on quality, patient safety, and standardized care delivery. However, studies have shown that poor coordination among hospital departments remains common. Research published in Indian healthcare journals indicates that approximately 60% of healthcare professionals report communication gaps between departments, resulting in delays, fragmented care, and reduced patient satisfaction. Constraints such as limited resources, infrastructure challenges, and high patient volumes further complicate coordination, especially in tertiary and public healthcare settings. "Delays in perioperative cataract surgery workflows are often attributed to communication gaps between ward and operating theatre teams, variability in staff and surgeon availability, patient comorbidities such as diabetes and hypertension, and inadequate patient preparedness, as reported in national guidelines and peer-reviewed studies." (WHO; NPCBVI; AIOS; Indian Journal of Ophthalmology; NABH) Even with advancing technologies and equipment's there is a need to improve communication and streamline the processes for reducing patient waiting time and increasing patient satisfaction especially in high volume surgical institution. It becomes more relevant in case of not for profit hospitals working in rural and tribal area and having ratio of 70:30 of free and paying patient. Tejas eye hospital is a charitable tertiary eye care hospital having yearly outpatient department (OPD) of more than 125000 and surgical operation of more than 13000. Tejas eye hospital also receives a good number of patients from underprivileged area on regular basis from its outreach program through diagnostic eye camps, vision centers, door to door screening and satellite center. The challenges are increased with visiting surgeons and other specialist. The arrival of the patients in pulsatile form, seasonal effects, relatively unaware clientage is likely to increase the possibility for communication gaps, clinical errors and protocol deviations. The purpose of this study is to examine how coordination between hospital departments affects patient flow between the ward and the operating theatre (OT) at a tertiary eye care hospital. This will be an Interventional study, conducted in two phases, using both quantitative and qualitative methods conducted at Tejas Eye Hospital. Patients scheduled for cataract surgery during the study period will be included. Phase 1: Two trained investigators would observe the process and collect the data in structured format from ward admission to transfer into the operating theatre. Every participant would be observed from the ward on the day of his schedule surgery till his surgery is over in operation theatre. Demographic details and personal characteristics of every participant would be recorded in data collection form. Patient name, age, gender, whether through referral, free or paying section. Date, time and month of operation and type of clinical conditions would be recorded for all patients by a trained investigator. Every patient would be observed throughout his/her movement from wards to operation theatre and observations would be made and recorded for duration of time required, communication made, reasons for delay, and preoperative preparations till start of cataract surgery. In this pathway, timings, events, errors, deviations would be recorded at different spots between ward and operation theatre in first phase of study. The data will be analyzed using MS excel and EpInfo. Summary statistics would be calculated for different variables and listing of various events and errors would be done. Using the above analysis various delays, communication gaps and different deviation would be identify. The findings would also be collated with patient satisfaction survey in this study. A dissemination meeting would be organized with all involved in above processes and findings would be shared in detail. Specific intervention would be decided for execution in the second phase of this study. Phase 2: Predetermined interventions from analysis of first phase would be implemented and similar data collection would be carried out to see the impact of interventions. Comparison would be carried out to establish the final outcome of the study. Similarly change in frequencies of errors and deviations would also be calculated. Aim: To optimize the cataract surgery operational workflow by evaluating coordination between the ward and operating theatre (OT) through measurement of ward-to-OT transit time, communication-related delays, and process deviations among patients undergoing elective cataract surgery at Tejas Eye Hospital. Primary Objective: To reduce pre-operative waiting time (ward call-up to OT entry) among adult cataract patients by 30% following the implementation of standardized ward-OT coordination protocols at the hospital within 6 months. Operational Definitions: Cataract Surgery Cycle Time: Time (in minutes) from ward call-up initiation to patient entry into the operating theatre. Management Delay: Any delay \>10 minutes attributable to: * Incomplete documentation * Staff unavailability * Surgeon changeover * Communication gaps between ward and OT * Patient readiness issues not related to acute medical emergencies Communication Error: Any documented instance of: * Incorrect or missing information during handover * Unclear responsibility assignment * Repeated clarification requests causing delay