Performing cataract surgery on both eyes in the same session, known as Immediate Sequential Bilateral Cataract Surgery (ISBCS), is clinically safe and highly cost-effective. Research shows outcomes comparable to “Delayed Sequential Bilateral Cataract Surgeries”, with cost savings of up to $3,776 per patient from a societal perspective and $2,200 from a healthcare perspective. Despite these advantages, few U.S. centers have fully implemented ISBCS because of workflow variations and safety concerns.
At the Kaiser Permanente Eye Surgery Center in Rancho Cordova, innovation is part of everyday practice. A multidisciplinary team of ophthalmologists, perioperative leaders, a nursing professional development specialist, clinical nurses, and scrub technicians worked together to improve the efficiency and safety of ISBCS through a standardized dual back-table setup.
A gap analysis at the Eye Surgery Center revealed non-standardized workflows and inconsistent setup practices for the dual surgical tables used during ISBCS. These inconsistencies caused inefficiencies, longer turnover times, and variation in sterile technique. To address these challenges, Nursing Professional Development Specialist Amelia Dayucos, MSN, RN, CNOR, Assistant Nurse Manager Hayle Murphy, BSN, RN, and Nurse Manager Ericka Osborn, BSN, RN, partnered with the ophthalmology and perioperative services teams to design an evidence-based, streamlined workflow to enhance surgeon efficiency, reduce turnover time, and strengthen patient safety.
Through process mapping and direct workflow observations, the team examined how surgeons, circulators, and scrub technicians prepared and transitioned between the first and second eyes. The analysis showed variation in instrument, equipment, and supply set-up, prompting the development of a standardized dual-table protocol. Using staff feedback and best practices from the literature, the team created visual diagrams, procedural checklists, and step-by-step guides to ensure each eye had dedicated, sterile instruments and clearly labeled supplies. This structured approach reduced cognitive load, improved flow, and eliminated ambiguity during the transition from one eye to the next.
After implementation, the standardized setup produced immediate benefits. Turnover times between eyes decreased, workflow efficiency improved, and staff reported greater confidence and consistency during ISBCS procedures. Surgeons noted smoother transitions, better pacing, and fewer procedural delays.