Time Requirements of Paper-Based Clinical Workflows and After-Hours Documentation in a Multispecialty Academic Ophthalmology Practice.

PURPOSE: To assess time requirements for patient encounters and estimate after-hours demands of paper-based clinical workflows in ophthalmology. DESIGN: Time-and-motion study with a structured survey. METHODS: This study was conducted in a single academic ophthalmology department. A convenience sample consisted of 7 attending ophthalmologists from 6 subspecialties observed during 414 patient encounters for the time-motion analysis and 12 attending ophthalmologists for the survey. Outcome measurements consisted of total time spent by attending ophthalmologists per patient and time spent on documentation, examination, and talking with patients. The survey assessed time requirements of documentation-related activities performed outside of scheduled clinic hours. RESULTS: Among the 7 attending ophthalmologists observed (6 men and 1 woman), mean ± SD age 43.9 ± 7.1 years, during encounters with 414 patients (57.8 ± 24.6 years of age), total time spent per patient was 8.1 ± 4.8 minutes, with 2.8 ± 1.4 minutes (38%) for documentation, 1.2 ± 0.9 minutes (17%) for examination, and 3.3 ± 3.1 minutes (37%) for talking with patients. New patient evaluations required significantly more time than routine follow-up visits and postoperative visits. Higher clinical volumes were associated with less time per patient. Survey results indicated that paper-based documentation was associated with minimal after-hours work on weeknights and weekends. CONCLUSIONS: Paper-based documentation takes up a substantial portion of the total time spent for patient care in outpatient ophthalmology clinics but is associated with minimal after-hours work. Understanding paper-based clinical workflows may help inform targeted strategies for improving electronic health record use in ophthalmology.

Patient-Reported Spectacle Independence Questionnaire (PRSIQ): Development and Validation.

PURPOSE: To develop a questionnaire quantifying spectacle independence following cataract surgery. DESIGN: Questionnaire design and validation study. METHODS: A literature review, expert clinical interviews, and patient interviews were undertaken to develop a patient-reported questionnaire assessing spectacle independence. Draft items were assessed and revised in a series of cognitive interviews where the instructions, recall period, and response categories were evaluated for understandability and consistency. The final draft items were evaluated in 2 quantitative studies. Confirmatory factor analyses, including item response theory calibration, were performed; reliability estimates were obtained; and validity analyses of the resulting scores were carried out. RESULTS: Qualitative research demonstrated that patients often considered themselves spectacle independent yet, when probed, it was determined that the respondent actually wore correction for certain activities. Moreover, despite what the respondents claimed about needing to wear correction and their actual use of correction, there were various levels of function reported when carrying out activities at several different distances without the use of correction. Using the qualitative results, the Patient-Reported Spectacle Independence Questionnaire (PRSIQ) was developed to assess spectacle independence via items that assess what patients say and do, and how they function at various distances. All quantitative analyses (eg, discriminant and convergent validity correlations, known-groups analyses) conform to predictions and support the use of the PRSIQ as a measure of spectacle independence. CONCLUSIONS: The PRSIQ is a patient-reported measure assessing spectacle independence following cataract surgery. The analyses conducted provide evidence for the use of the PRSIQ total score as a measure of spectacle independence.