Development of a Patient-Oriented Organizational Management System for Intravitreal Injection Therapy in a Standardized "Treat-and-Extend" Regime at a University Eye Clinic. / Entwicklung eines patientennahen Organisationsmanagements für die intravitreale Injektionstherapie in einem standardisierten "Treat-and-Extend"-Regime an einer Universitäts-Augenklinik.

BACKGROUND: The treatment of macular edema with intravitreal injections has revolutionized the treatment of associated diseases in ophthalmology. However, with a few exceptions, this is a chronic treatment where patients require many injections and usually need to stay in treatment for years. Patient adherence and control of patient flow are critical to treatment success. In this manuscript, we describe the development of a patient-oriented organization management for intravitreal injections in a university hospital. MATERIAL AND METHODS: In 2015, the intravitreal treatment in our clinic was switched to the treat-and-extend regime. At the same time, the optimization of the previous organizational processes in perioperative management was evaluated. For the period 2015 to 2018, we analyzed and gradually optimized the procedures of our intravitreal injection therapy in a survey with a specialized service provider. RESULTS: Through the analysis of the original processes, the patient appointment was optimized, work processes were summarized, spatially reorganized and there was only a slight increase in the number of staff involved compared with the significant increase in the number of injections. Through these measures, the total in-hospital-time of the patients could be drastically reduced and at the same time the number of patients on one operation day could be multiplied. CONCLUSION: In the context of chronic treatment with intravitreal injections, the care of an increased number of patients is a logistical challenge. By optimizing processes, existing resources can be better used to meet the increased demands. An optimized system offers the patient greater adherence and a better visual outcome largely independent of the medication used.

Ranibizumab prefilled syringes: benefits of reduced syringe preparation times and less complex preparation procedures.

PURPOSE: A recently developed ranibizumab prefilled syringe (PFS) eliminates several preparatory steps versus the standard vial-based method, and is expected to reduce syringe preparation time (SPT) and enhance procedural simplicity for intravitreal injections. METHODS: Syringe preparation times for the ranibizumab PFS and vial were recorded during standard treatment sessions at 2 centers, without randomization. The duration of each step in preparing the syringe was recorded. At each center, total SPT (mean total duration of all syringe preparation steps) for each method was compared using a 2-tailed t test. RESULTS: In total, 97 SPTs were analyzed across both centers. Center 1 SPTs were 46 seconds (PFS) versus 75 seconds (vial; difference, 29 seconds; p<0.001). Center 2 SPTs were 46 seconds (PFS) versus 63 seconds (vial; difference, 17 seconds; p<0.001). This equates to a 27%-39% reduction in SPT when using the PFS rather than the vial, resulting mostly from the reduced number of syringe preparation steps associated with the PFS. CONCLUSIONS: Syringe preparation times for ranibizumab intravitreal injections are significantly shorter with the PFS than with the vial. The time saved by using the PFS may benefit physicians and nurses, and the simplicity of the injection preparation process with the PFS is advantageous.