Economic modelling of immediately sequential bilateral cataract surgery (ISBCS) in the National Health Service based on possible improvements in surgical efficiency

OBJECTIVE: To test a hypothesis that operating room (OR) productivity in the National Health Service (NHS) can be improved with the introduction of immediately sequential bilateral cataract surgery (ISBCS). METHODS AND ANALYSIS: Previously published time and motion data of 140 unilateral cataract surgeries conducted at five different NHS locations were reanalysed to construct a hypothetical model where only ISBCS (±one unilateral case) were conducted while maintaining time durations of all key tasks previously studied. Possible time efficiency savings were calculated for the ISBCS model and percentage increases in numbers of eyes operated per 4-hour theatre session calculated. Gains in efficiency were correlated with factors from the baseline data to predict which settings could improve efficiency most by undertaking ISBCS. RESULTS: Based on remodelling our time and motion study (TMS) data as hypothetical ISBCS cases, we could expect a mean 16% reduction (range 9.8%–17.8%) in the time taken for two cataract operations, translating into a mean 54% improvement (range 38%–67%) in number of cases currently performed per list and an 18% improvement (range 9%–28%) even if the number of unilateral cases per list had been fully maximised. An average number of four ISBCS cases per list (range 3–6) were required to achieve sufficient time savings to allow an extra unilateral surgery to be conducted. CONCLUSION: The introduction of routine ISBCS has the potential to improve the productivity of cataract surgery within the NHS, with efficiencies being possible in both high-volume and low-volume surgical models.