Lean approach to the management of patients undergoing intravitreal injections during COVID-19 pandemic

Marco Verolino; Piergiacomo Grassi; Gennaro Sosto; Gaetano D'Onofrio; Stefania De Simone; Ciro Costagliola

doi:10.1177/25158414211018893

Lean approach to the management of patients undergoing intravitreal injections during COVID-19 pandemic

Ther Adv Ophthalmol. 2021 Jun 17:13:25158414211018893. doi: 10.1177/25158414211018893. eCollection 2021 Jan-Dec.

Authors

Marco Verolino¹, Piergiacomo Grassi², Gennaro Sosto¹, Gaetano D'Onofrio¹, Stefania De Simone³, Ciro Costagliola⁴

Affiliations

¹ ASL Napoli 3 Sud, Ospedali Riuniti Area Vesuviana, Naples, Italy.
² Clinical Fellow in Vitreoretinal Surgery, Department of Vitreoretinal Surgery, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK.
³ Institute for Research on Innovation and Services for Development (IRISS), National Research Council (CNR), Naples, Italy.
⁴ Full Professor in Ophthalmology, Department of Medicine and Health Science 'V. Tiberio', University of Molise, Campobasso, Italy.

Abstract

Background: To introduce Lean approach principles in the management of patients undergoing intravitreal injections (IVIs) for wet age-related macular degeneration.

Methods: Retrospective single-centre cohort study. Services location, IVIs scheduling, utilization of staff, data recording methods, ophthalmic examination and surgical procedures were analysed; a new Intravitreal Injection Centre (IVIC) was developed according to Lean principles. Mean number of daily IVIs performed, mean time between registration and discharge, mean turnover time in between patients, percentages of performed IVIs on the monthly scheduled IVIs and of patients rating their experience ⩾8/10 via standardized feedback questionnaires were retrospectively analysed.

Results: The mean IVIs number per day increased from 20 ± 4.08 to 50 ± 7.07, and the mean time between registration and discharge of a patient decreased from 240 ± 14.14 to 60 ± 8.16 min (p = 0.00057 and p < 0.00001, respectively). Mean turnover time in between patients decreased from 10 ± 1.41 to 8 ± 2 min (p = 0.055). The percentage of monthly IVIs performed on the total of scheduled IVIs increased from 60% to 100%, and the percentage of satisfied patients who rated IVIC ⩾8/10 increased from 45% to 95% (p = 0.0177 and p < 0.00105, respectively).

Conclusion: The IVIC improved the quality, efficiency, speed of the overall procedures and clinical capacity of the IVI service through a fast one-way route for patients, limiting time wasted and total distance travelled. This model facilitates the creation of a one-stop clinic through the just-in-time management principle and may be relevant to other ophthalmology services.

Keywords: Intravitreal Injection Centre; Lean methodology; age-related macular degeneration; anti-VEGF; intravitreal injection; patient care management.