Karen Gibson is sitting quietly in a hospital waiting room chair. An ‘x’ is drawn in black marker above her right eye, and that eye’s pupil is growing larger as the minutes tick by. At the age of 60, Gibson is about to have a cataract removed. In half an hour, she’ll begin to see clearly again.
She looks around the room, smiling excitedly.
All around her, nurses and doctors are interacting with other patients, who each bear the same black mark above an eye. As they arrive, each one is screened by a physician for potential complications. Some of the more nervous patients are just starting to feel the effects of mild sedatives. They all wait to be moved along the queue, and closer to the operating room.
That line moves quickly and efficiently under the watchful eye of two registered nurses, Brenda Roberts and Denise Deworth.
While it’s just a typical work day at the Eye Care Centre at Chilliwack General Hospital, the centre is anything but ordinary. There is innovation at work at every turn, from wait times to resource management.
Dr. Heinrichs, one of the clinic’s six ophthalmologists, notes that the centre is highly regarded in the world of medicine.
“It’s truly a gem,” he said. Other hospitals have visited the centre to emulate its success, and SFU’s school of business analyzed the centre’s innovative business plan.
Gibson is about to undergo one of the 5,000 eye surgeries that will take place at CGH this year. She’s arrived from Aldergrove, but other patients travel from as far away as B.C.’s Interior region, and further north.
On the day Gibson visits, the centre will treat about 25 patients with cataracts. Some learned they have cataracts through an eye exam in their home town. Others may have been living with varying degrees of blindness for years. All are about to feel the real impact of advancements in ophthalmology.
“Thirty years ago, patients would come into the hospital for cataract surgery and stay for three days,” explains Dr. David Heinrichs. The surgery would take more than hour, and was “fraught with potential problems for the patients.”
The surgery would have taken place within the rigid structure of the main operating rooms, requiring patients to change into gowns. In those days, they were lucky to get in 12 or 15 surgeries a day.
But with today’s advancement, and his finely-honed skills as a surgeon, Heinrichs will complete Gibson’s surgery in seven minutes. She’ll be sent home that day, provided there aren’t any complications. It’s pain-free, and she will stay in her own clothes, awake and aware of the procedure.
The hospital shifted to the ambulatory care model in 2003, following planning sessions that included Heinrichs, Fraser Health, the CEO of the hospital, an OR nurse and local ophthalmologists. Their vision became a reality thanks to hefty donations from service clubs, businesses and individuals who believed in the project’s worth.
“Conceptually, it’s a unique idea,” Heinrichs said.
They renovated that year, dedicating two operating rooms on the second floor of CGH that are connected with a scrub sink hallway. An adjoining room serves the waiting and recovery area.
“Being under the main OR structure involves a lot more protocol,” Heinrichs said. “Because of this change to ambulatory care, we can now have people walk in, with no gurney or corridors to be pushed through. It’s just as simple as going to the dentist. It’s way more relaxed.”
The ambulatory model has freed up the regular operating rooms for other surgery needs, and the wait times for cataract surgery at CGH have now gone from more than a year, to about two to three months. In some special cases, Heinrichs said, that wait can be shortened even more.
A man from northern B.C. recently learned that cataracts had brought his vision to the critical 20/50 level.
“He’s a truck driver, and so he lost his license,” Heinrichs said. “The wait in Prince George is at least a year. We expedited it and he will be done treatment within a few weeks.”
So, instead of losing income for an entire year, he’s lost less than a month of work. And once the surgery is done, that patient will appreciate how bad his vision slowly became. For some patients, the growth of the cataracts are so slow they can go unnoticed. And for those who are legally blind from their cataracts, a difference in wait times can mean fewer injuries from falls, and more enjoyment of life in general.
Only one eye is treated at a time, with a wait time of about a week between surgeries. All cataract surgeries are now completely covered by BC Medical, making the medicine available universally. The day after surgery, the patient visits their ophthalmologist in his or her private practice.
“We get them seeing again,” Heinrichs said. “I have the best job in the world.”
Gibson’s cataracts are “fast growing” and were found by her eye doctor in Aldergrove, in October 2014.
“My older sister had had one, so I guess I’m following in the family tradition,” she said, laughing.
About 15 minutes after arriving in the waiting room, Gibson is moving into an operating room. She is met by the RN, an OR tech, and the doctor, and is quickly prepped for surgery. A television screen shows Gibson’s eye up close, as Heinrichs begins to use sound waves (phacoemulsification) to break up the cataract. A small incision is made and the fluid from the lens is drawn out. Water is continually flushed into Gibson’s eye, as a soft lens is inserted into her eye. It slowly unfolds and takes it place, and Gibson can see light like “a kaleidoscope of colours.”
In another few minutes, the doctor is heading out of the room to the adjoining hallway, where he’ll clean up in preparation for the patient being brought into the second operating room.
As Gibson leaves her surgery room with the help of a nurse, the room is cleaned and ready for yet another patient.
It’s a smooth cycle that runs throughout the day and allows the ophthalmologists the ability to focus on the task at hand. All the staff are trained to all the jobs within the centre, and they rotate tasks in the day to “keep things fresh.”
The centre couldn’t operate without their dedication to their jobs, Heinrichs said.
“They’re as valuable as gold,” he said.
The patients think so, too. In addition to flowers and gifts that arrive regularly from past patients, Roberts says see the joy in their patients’ eyes daily.
“We get hugged every day,” she said.