While having protocols in place can help streamline operations and keep a practice running well, the COVID-19 pandemic has thrown a wrench into even the most finely tuned processes. Consider for example, new cleaning and disinfection protocols. (See “Spick and Span,” on p.18.) In addition, when addressing primary care optometry, the optometrists interviewed in this article report they have adapted the following practices — most of which they feel are here to stay.

CROSS-TRAINING

Those interviewed say flexibility in job duties is important; they’ve seen so much value in this team mentality, that cross-training is not going anywhere.

“I told the staff, ‘if you were trained to be a tech, be prepared to also be a billing person, eyeglasses person and even a contact lens person,’” explains Timothy Earley, O.D., of Medina Vision and Laser in Medina, Ohio. “We had previously been a very compartmentalized office, and now the lines are blurred with members of all departments working in all areas and, frankly, it works.”

He adds that the key to success with cross-training staff is relying on senior staff members “to lead the charge,” as they have experience in serving the practice in several different roles.

Robert L. Bass, O.D., F.A.A.O., of Dr. Bass and Rose in Manassas, Va., says that cross-training has always been a protocol at his practice, but that the COVID-19 pandemic provided time to do it better. Now, every employee has been extensively trained to “step in anywhere,” he acknowledges.

This includes cleaning.

“When a patient leaves the exam room and we’re getting ready to take the next person back, anyone who is free is in there cleaning,” he explains. “We’re constantly keeping everything in motion with everyone organized and trained. As a result, we’re operating smoothly and efficiently.”

His tip regarding cross-training: Train and practice one technical aspect at a time. For example, a specific procedure may be easy, but getting the correct verbiage for patient understanding can be difficult, Dr. Bass says.

ADMINISTRATIVE TECHNOLOGY

Although administrative technology isn’t new, it’s something those interviewed say they have taken greater advantage of as a result of the COVID-19 pandemic.

“I think we were using about 5% of what our EHR system could do. Now, that figure is more like 100%,” Dr. Bass says. “Everything is now digital and stored in the patient record to be compliant. Our system also came out with a way to enable telemedicine visits in which patients connect to me through a secure link, and I can open their record while we’re on that visit.”

He adds that now that patients have experienced these options — including online scheduling — he thinks they’re going to want to keep them.

This benefits the practice as well: “The EHR we use has an iPad app that contains a consent tab,” Dr. Bass explains. “Since COVID-19, we have quit all paper consent signing and have uploaded all of them to the consent tab. Patients now use a hand-sanitized finger to sign on the iPad, which stores the consent in the patient’s record. No more paper and scanning the consent into the patient’s record!”

Eric M. White, O.D., of Complete Family Vision Care, in San Diego, Calif., addresses telehealth:

“One of the biggest changes to our standard operations has been the introduction of telehealth, which is absolutely here to stay,” he says. “It’s certainly not new, but we weren’t doing it before COVID-19. Now, it’s become routine for us, and patients love it. It’s great for routine follow-up visits, a glasses check or for evaluating a basic disease condition, such as pink eye. And patients love that it saves them so much time.”

UTILIZING SQUARE FOOTAGE WISELY

Using space wisely, particularly in a smaller practice, has always been important, as efficient patient flow and the prevention of bottlenecks keeps operations streamlined. That said, the COVID-19 pandemic has prompted additional ideas, say those interviewed.

For Dr. Earley’s part, its hand-held credit card machines born out of the need to prevent billing bottlenecks and to adhere to social distancing.

“The machines are throughout the whole office, so everyone is a billing person,” he says. “We can physically bill in the exam lane, in the contact lens dispensary or anywhere else, and those bottlenecks are eliminated.”

He adds that the practice has enforced scheduled eyewear-dispensing visits.

“Traditionally, there were always certain times of the day — particularly that 4 p.m. to 6 p.m. hour after school and work — where we had a long line of people waiting for glasses,” Dr. Earley recalls. “With a scheduled visit, there’s no waiting, which patients appreciate for both its fast service and safety.”

ADAPTING DURING TIMES OF GREAT CHANGE

The COVID-19 pandemic has heaved a lot of change at once, but practices, like the ones discussed above, have adapted and even adopted new best practices they say they’ll maintain even after the virus has subsided.

“Optometry is going to survive — and even thrive,” says Dr. White. “We’re going to be okay. We are in the midst of a learning curve right now, as we realize that the previous ways of doing things may never be coming back. Our practices have had to change.” He adds that primary care O.D.s truly care about their patients. “They’re our family. We’ll do what needs to be done to protect our family and carry on.” OM

Spick and Span

Many of the protocols for ocular assessment have always centered on cleanliness: After all, keeping instruments clean and sterilized is paramount to patient safety. That said, the COVID-19 pandemic has inspired new cleanliness routines that those interviewed for this article believe will remain in place after the pandemic ceases. (See CDC guidelines at bit.ly/3dMpgVV , in recognizing that O.D.s are learning from each other’s protocols as well.)

For example, Dr. White says his practice now clips a “This room has been sanitized” laminated card to the door after cleaning has been completed, as doing so helps keep track of the state of the practice’s four exam rooms, while providing a visual for worried patients.

He adds that slit lamp shields and “elbow bumps” (vs. hugs and handshakes — a difficult transition for Dr. White) are also a part of the practice’s safety protocol that are likely here to stay because patients’ awareness of germs isn’t going to just go away even when the pandemic has subsided, he notes.

“One thing that hasn’t changed is that I come in and greet the patient and wash my hands in front of them,” Dr. White explains. “It sets a tone that we care about their safety.”

Dr. Earley adds that “gloving up and masking up” are new policies that he expects will remain.

“The more barriers, the better,” he emphasizes. OM