Day Care Centers – Small Is Beautiful NSD Raju Ranjini Eye Hospital (India’s first NABH Accredited SHCO ) It is now accepted that ambulatory surgery--performed in a hospital-based, free-standing, or office-based unit--can be safe, efficacious and cost-effective. In fact day care ophthalmic centre are a well estblished concept Establishment of a successful ambulatory ocular surgery unit requires thorough knowledge of pertinent local, regulations, as well as understanding of both the physical and functional needs of such a facility. The phenomenal adfnaces in the technology and techniques of ophthalmic surgerey has ensured safe outpatient care for intaocular surgery .This concept has been well accepted by Indian ophthalmology and the successful perrforming the day care ophthgalmic centres is a etstament to its poularity and usefulness . Let us look into the the nsucess story of these stand alone institutions and how they have established definile role in ophthalmic care and surgery

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Day care Ophthalmic surgical Center Small Health Care Organization ( SHCO) Ambulatory Ophthalmic Surgical Centre These modern day care ophthalmic Centres have been categorized into Small Health Care Organizations along with hospitals with less than 50 beds and together they constirute nearly 80 per cent of Ophthalmic Centres in the country

Ambulatory Ophthalmic Surgical Centre Out patient ophthalmic surgery Most surgical procedures Cataract surgery forms the bulk of Ophthalmic surgery Vitreoretinal surgery Oculoplastic surgery In this modern era of ophthalmic surgery most proceedures are done on an ambulatory basis , cataract of course forming the bulk of the out patient surgery Majority of vitreo retinal, ant segment surgery and oculoplastic surgery are being successfully performed on an out patient procedure

Location Area and Ambience Preferably open space Accessibility Parking facility Adequate built up area usually 2000 – 6000 sq.ft The day care centre should ideally be located in an open space with easy accessibility and enough parking facility. Depending on the facilities offered the built up area should be 2000-6000 sq feet We have about 6000 sq.in our centre and we in our centre both anteror segment and posterior segment surgery

Components of the Ophthalmic Clinic- the Reception One of the most important divisions Wide enough to handle inflow Registration process Adequate number of receptionists Reduce waiting time smooth registration Our reception area A most important and essential component of the Centre Spacious enough to handle inflow of patients and registration process. Adequate number of receptionists would ensure reduced waiting time and smooth registration process

The Waiting Areas Primary area large enough to handle inflow Secondary waiting area - to preliminary screening and to consultants Comfortable seating This is primary area large enough to hanle the inflow quite cosy and comfortable . Waiting patients will then be moved to the secondary waiting area prior to preliminary screening and subsequent examination by the consultants

Preliminary Screening Areas Easily accessible from waiting areas Vision Autorefraction and refraction Non contact tonometry These are easily accessible to waiting patients seated at the secondary waiting area. Vision, auto refraction and refraction non contact tonometry are all done here before the patient is directed to the consultants

Designing the Consultation Rooms Number of consultants Placement of equipments ophthalmic unit Comfortable seating arrangements The consultation rooms are all elegantly designed and equipments and seating arrangements planned to suit the convenience and comfort of patients and accompanying persons . The ophthalmic unit module placement must be at the most convenient location in the room

Designing the Consultation Room Enhance the ambience Diffused lighting Pleasing soft music Our consultation room ambience is further enhanced by the diffused lighting and the slow flowing soft music. This certainly helps to ease the apprehension which many people have during medical check up

Designing the consultation Room Ensure easy access of ophthalmoscope and lenses Enough room for nursing staff to assist The designing of the room should also be such that the consultant has easy access to the ophthalmoscope, the various lenses and other ancillary devices. There shold be enough room for nursing staff to assist and move about

Investigation Areas Ideally located in separate rooms same nearby locatio Automated perimetry Imaging services Fundus Camera OCT Corneal topography Patient counseling room It is ideal to have separate rooms for different investigations . We have them located at different rooms but within the same complex

The surgical Suite Design with care and caution Single complex Reception Area Buffered by pre sterile area separate from OPD II floor all in one complex Pre operative and post operative care Sterilization , digital scrubbing adjacent to O R Designing the surgical suite and complex has to done with extreme care and caution. If possible it is better to have the surgery complex exclusively in one floor. We have such a set up with a reception area located at the entrance to the complex. Then the Operation room is buffered by a semi sterile area which designed for pre operative and post operative care The reception the pre op care the surgery, the immediate post op care and the final discharge everything is from the surgery complex.

Ultra clean Operation Room Ultraclean O R Most crucial component HEPA filter System High Atmospheric Pressure Hermetically sealed door Sensor controlled Most crucial component in the day care ophthalmic surgery centre. Must be large enough to accommodate the various equipments and provide adequate room for moving about. We have area of 500 sq foot sufficient for one operation table. There are 2 such or in our surgical complex The ultra clean OR has the HEPA filter system and a maintains a slightly high atmospheric pressure to prevent contamination of outside air. It has a hermetically sealed door which is sensor controlled

Efficiency Enhancing Measures- Electronic Medical Record (EMR) Enhanced efficiency -Patient data , clinical, diagnosis ,treatment outcome etc Networking system 5 consultants and departments Imaging, Perimetry results direct to EMR Accessible to all Establishing an EMR system has enhanced the efficiency of our day care surgical centre to a great extent We have five consultant ophthalmologists and the efficient networking system allows access to all data of patients Imaging and investigation results are immediately fed into the networking syst and can accessed by the consultant

NABH Accreditation First Accredited Day Care Ophthalmic Centre Benchmark withWorld class quality Care Enhanced Medical tourism patronage Insurance company recognition Empanelment in CGHS and ECHS Complete conversion to EMR Our day care surgical centre in fiirst NABH accredited hospital in the country in the small health care organization category. The accreditation has helped us achieve quality ophthalmic health care and benchmark with world class ophthalmic treatment, and these are some of the other benefits following accreditaion

Other Measures MOU with Hospital for Patients needing admission/emergency Arrangement for ambulance Facility All day care ophthalmic canters also should have a n MOU with Nearby hospital for any possible admission or emergency . This should include provision of Ambulance facility as well We have made such an MOU with a well established tertiary Hospital and occasionally utilizing this facility

Conclusion Success story Clinical efficacy and usefulness State of the art world class surgical care Important modality The success story of Ophthalmic day care surgical centre clearly demonstrates their clinical efficacy and usefulness to the society. And by delivering safe state of the art, world class surgical care to the patients these ambulatory surgical centers have established themselves as an important modality of safe surgical ophthalmic care system in the country.

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