Innovating in times of crisis

Lessons learnt from New York in the COVID-19 pandemic

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Jeffrey Liebmann MD
The COVID-19 pandemic has changed the world in profound ways and ophthalmic practices will need to adapt, innovate and rethink their ways of managing patients in order to make the transition as safely and effectively as possible, according to Jeffrey Liebmann MD. “If we think that things are going back to the status quo before the pandemic, I think that we're mistaken. There will always be some virus in the air over the next year or two and if we seek the old status quo, we are going to fail,” Dr Liebmann said at a special COVID-19 symposium at the World Ophthalmology Congress 2020 Virtual. Discussing the lessons learnt in New York from the pandemic, Dr Liebmann, Director of the Glaucoma Division of Columbia University Irving Medical Centre, said that his department had implemented a number of guiding principles to help aid recovery from the COVID-19 crisis. “The first principle is to remember to continue the clinical, teaching and research missions of the department, including the highest level of expert clinical care and surgery. Many of us who are in private practice also have teaching responsibilities to our resident trainees and medical students. We have responsibilities to our fellow researchers as well, so it is important to maintain these activities,” he said. The next important measure is to ensure a safe environment for patients, faculty and staff, said Dr Liebmann. “We all know that ophthalmologists are at much greater risk for developing this disease and we need to maintain all of our protections in place going forward. We need to ensure strict patient screening and sterilisation protocols and minimise in-person visit frequency and examination time. We cannot have the same density of patients as before, so it also increases our working hours,” he said. Organising the workflow and clinic space with new protocols in place for social distancing and sterilisation is a complex task that requires a lot of thought and administrative time by physicians and other staff, added Dr Liebmann. “To solve a lot of these problems, we need to innovate, to rethink our clinical care models and explore new opportunities. We have determined that we can safely see approximately four patients per hour per doctor to maintain social distancing between patients as they enter and leave the office setting. We have our doctors working five-hours sessions, six days a week,” he said. To try to reduce the backlog of patients, visit stratification is very important, said Dr Liebmann. “Some patients don't need to come in straightaway and can have a video consultation. We also have testing and procedure days that don't involve physicians, but where patients can come in and leave the office easily. We are also changing our diagnostic testing models and we perhaps need to do more imaging than perimetry. Sterilising a perimeter is a very difficult task and is not easily done, and it is not really clear how well patients perform perimetry with masks on. We only perform dilation when necessary,” he said. Novel drug treatments with longer-lasting effects may also help to reduce the need for office visits going forward, he added. Every aspect of patient care needs to be re-examined and re-adjusted where necessary. “For example, we have instigated quicker visits, where our patients come in, have imaging, get their pressure checked followed by a patient discussion in that order rather than going into a more convoluted approach to care. We try to minimise contact and procedures as much as possible,” he said. Rebuilding the financial strength of the practice is important by setting targets for a phased return to full activity, said Dr Leibmann. He also stressed the importance of maintaining staff and physician morale at a time of immense stress and worry. “We have to remember that everyone is under stress - people are losing family members. The staff are worried about getting the disease from a patient and transmitting that to their families at home. These are issues we need to address and be aware of as the physician leaders – just as we take care of patients, we also need to take care of our staff,” he said. With every crisis also comes opportunity, concluded Dr Liebmann. “We have an opportunity perhaps to improve our care and make lemonade from all the lemons we've been given. We desperately need to rethink our clinical care model. This is a good time for us to really focus on what's important. As we rebuild our financial strength to do new things, I think we should look forward to a day of different care models that will help us greatly in the future while maintaining staff and faculty morale and engagement,” he said.
Tags: covid-19, World Ophthalmology Congress 2020 Virtual