Cataract surgeons and their staff will often take a surgery “time out” in which the entire OR staff pauses and confirms such things as the patient’s identity, the correct eye to be operated on and if the procedure that’s about to be performed is, in fact, the procedure the patient was scheduled to have. This simple break in the action can avoid horrendous errors and their knock-on effects, and has proven very useful for ophthalmic practices.
It turns out these time outs work for other things too, like leaving for a flight: One time, when packing for an ASCRS meeting, I took a time out before closing my suitcase and discovered I hadn’t packed any belts!
Or family trips: We drove two hours to an amusement park only to realize we’d left the tickets at home. (I didn’t say I always took time outs, just that they work.) The six hours I spent on the road that day were almost as painful as having my wrong eye operated on.
And now, thanks to an interesting study in the April issue of JAMA Ophthalmology, it appears that taking a step back and evaluating how ophthalmologists perform cost/utility analyses can pay dividends as well.
In the study, Gary Brown, MD, of the Center for Value-Based Medicine, and his co-authors queried 309 non-ophthalmic-patient subjects and 505 ophthalmic patients regarding the perceived utility of cataract surgery and intravitreal ranibizumab for wet age-related macular degeneration. They also looked at the responses with and without the application of “systemic comorbidity” limits (a theory of cost-utility analysis that says the utility of an ophthalmic intervention will be capped, in a sense, by the co-existing negative effects of diseases the patient already has).
The researchers found that using non-patients to quantify the quality-of-life benefits of interventions and the systemic comorbidity utility level “cap” resulted in large decreases in calculated patient value in terms of quality-of-life years as well as in cost-effectiveness, and potentially discriminated against disabled, elderly and African-American patients. It turns out that, if you want to get an accurate picture of how a surgery or other treatment will impact a patient, you probably should ask a patient with the disease, rather than an objective source. The authors say that identifying this negative potential bias can help avoid the denial of beneficial interventions for patients, the loss of research funding, the slowing of advances in treatment and the potential decrease in reimbursements for treatments.
It’s refreshing to see that something as simple as taking a time out to stand back and evaluate a process and make sure nothing’s been missed can be as effective in the complex world of medical cost-utility analysis as it can in the simple task of packing belts in your suitcase.
In both instances, you make sure that you don’t miss anything important and, in the end, you don’t get caught with your pants down.
— Walter Bethke
Editor in Chief