End-to-End Impact of a Cloud-Based Surgical Planning System on Efficiency in Cataract Surgery: A Time-and-Motion Study

Abstract

Purpose

Inefficiencies from manual data entry and non-integration exist throughout the cataract surgery workflow. The aim of this study was to evaluate the impact of SMARTCataract, an innovative cloud-based digital surgical planning platform (SPS) on efficiency in preoperative (diagnostic workup, surgery planning), intraoperative, and postoperative phases of cataract surgery. The primary objective aimed to assess time and number of manual transcription data points (TPs) required for all pre-, intra-, and postoperative devices that integrate with the SPS and surgery planning time across three patient types (post-refractive, astigmatic, conventional). The secondary objective aimed to assess the overall efficiency impact of the SPS on the surgery workflow for the three patient types by leveraging time-and-motion methods and workflow mapping.

Patients and Methods

This prospective, observational, real-world, pre- and post-cohort time-and-motion study included patients undergoing evaluation for cataract surgery and/or surgery at the study site. Assessed variables included time and TPs required for clinical activities and devices associated with traditional manual methods (pre-cohort) versus the SPS (post-cohort). Statistical analyses (t-test) were performed comparing performance time using the SPS versus traditional methods for each integrated technology and surgery planning activity.

Results

The SPS demonstrated statistically significant time savings over traditional methods in TP data input time taken across all integrated pre-, intra-, and postoperative devices (p<0.0001). The SPS additionally demonstrated statistically significant time savings in preoperative surgery planning across post-refractive (p<0.0001), astigmatic (p=0.0005), and conventional (p=0.0004) cataract patient groups. Overall, the SPS reduced end-to-end patient workflow time and TPs for post-refractive, astigmatic, and conventional cataract patients by averages of 13.2, 12.6, and 4.3 minutes and 184, 166, and 25 TPs per patient, respectively.

Conclusion

Through the SPS’ integration and surgery planning capabilities, substantial time efficiencies can be achieved for cataract surgery practices, clinicians, and patients compared to surgery planning with traditional manual methods.

Keywords:

• time efficiency
• surgical planning software
• real-world observational study
• manual transcription

Abbreviations

IOL, intraocular lens; OCT, optical coherence tomography; OLCR, optical low-coherence reflectometry; OR, operating room; ORA SYSTEM, Optiwave Refractive Analysis SYSTEM; SD, standard deviation; SoC, standard of care; SPS, surgical planning software; SS-OCT, swept source optical coherence tomography; TP, transcription point.

Acknowledgments

Special thanks to Thomas Goss, Robert Wenthold, Manasi Datar, and Salwa Masud from Veranex Solutions, Inc. (“Veranex”) for providing editorial assistance in the preparation of this manuscript and Michelle Saylor from Veranex for supporting a portion of the data collection.

Disclosure

This study was supported by Alcon Vision, LLC (“Alcon”) (Fort Worth, Texas). Alcon is the market authorization holder of SMARTCataract. Veranex (Boston, MA) received funding from Alcon to conduct this study as a third-party research consultancy. LP and KM are employees of Veranex, HC and DO are employees of Alcon, and ZZ is a consultant for Alcon.