Impact of digital cataract workflow on time and resource efficiencies in cataract surgery: time and motion study

Purpose: To compare time and resource-saving with integration of digital cataract workflow to the existing workflow in high-volume cataract surgery clinics. Setting: L V Prasad Eye Institute, Hyderabad, India (Site 1) and Narayana Nethralaya, Bengaluru, India (Site 2). Design: Prospective, time-and-motion. Methods: The total time to complete each step (preoperative measurements, surgical planning, and surgical procedures) of the cataract workflow, number of data fields entered, and support staff required for both workflows were recorded. All study measurements were determined first for existing EMR cataract workflow followed by digital workflow (integrated data management system with data reviewer, surgical planner, and data transfer to OR) at both sites. Results: A total of 85 (Site 1, 44; Site 2, 41) cataract workflows were analyzed. The integration of digital workflow into the site’s existing EMR workflow reduced the mean time for preoperative measurements by 25.3% ( P = .006), surgical planning by 55.1% ( P = .008), and surgical procedures by 22.6% ( P = .002). The mean±SD overall time for the surgery was significantly shorter in the digital group (887.3±103.3 vs 1271.3±300.7 seconds; P < .0001). For both sites, the number of data fields recorded and the number of support staff needed was significantly lesser for the digital workflow ( P < .0001, for both). Conclusions: Integration of digital workflow significantly reduced the overall cataract surgery time, variability of overall time, number of data fields recorded, and resource utilization. Complete digitalization has important implications for improving the efficiency and standardization of cataract surgery workflow.