Singapore National Eye Centre has cut its fees for 19 complex procedures by 15% to 32% in March 2019, and streamlined its workflow since January, shortening the waiting time for patients.
For instance, in the case of intravitreal injection for patients with Age-Related Macular Degeneration, the cost has been reduced from the previous $133 to the current $96, a reduction of about 28%. Cost for Glaucoma Implant Surgery, Retinal Detachment Surgery, and complex surgeries such as Dacryocystorhinostomy for subsidise patients have also been cut by 25%.
Associate Professor Ian Yeo, Senior Consultant at the Retina Centre, SNEC, is responsible for streamlining the work processes for intravitreal injection. The medical treatment was made available since 2006 and the Centre now performs close to 16,000 procedures yearly.
Most patients undergoing intravitreal injections were diagnosed with Age-Related Macular Degeneration or Diabetic Retinopathy. The duration of the treatment depends on the patient’s condition. Some patients would need to go for the injection once a month, while others once every few months. The procedure involves using a needle to inject the drug directly into the white part of the eye beside the cornea.
Associate Professor Ian Yeo pointed out in the interview with Zaobao that the intravitreal injection was originally performed by doctors. However, the center reviewed its care models last year and trained six senior nurses to take on the role of administering the intravitreal injection for patients. These nurses have been providing this treatment to patients since January this year. Two more nurses are currently undergoing training. He said: "Previously, doctors could only go to the injection room to administer the injections after they have seen their patients at the outpatient clinic, very often during lunchtime, As a result, many patients ended up waiting for the injection outside the injection room.
"We only have two injection rooms. Sometimes even when we have time and when we get to the injection room, there was already another doctor inside. This way of working was actually not efficient at all."
In the past, doctors could only handle up to four patients in half an hour.
The procedure of injecting the drug takes only five seconds, but the nurse has to check the patient's personal particulars a few times, prepare for the procedure, and clean up and disinfect the area and equipment after the procedure is completed. As such the doctor can only handle up to four patients in half an hour.
It is understood that 30 patients undergo intravitreal injection at SNEC daily, and sometimes it can go up to 80 patients.
Now, professionally trained nurses can perform the procedure that only doctors can do in the past, which not only reduces the patient's waiting time, but the patient also does not have to pay the doctor’s fees, thus lowering the cost of the procedure.
Prof Yeo said: "The patients now go directly to the injection room for injection after seeing the doctor and no longer subject to the doctors’ availablity. We hope to have a dedicated group of staff responsible for IVT treatment, which can be carried out in tandem with the doctors’ clinic sessions. Patients will still get to ask the doctor if they have any questions. We believe that this change has subverted the previous operation model and is beneficial for both the patients and doctors."
Senior Staff Nurse Huang Shimin (38 years old) said: "The patients have been very accustomed to having the doctor performing the injection. When they first knew that the nurse will be carrying out the injection, some of them were doubtful. We took time to explain to them. But what is obvious is that the long waiting time has been reduced."
Elderly patient, Mr Ishak (63 years old, driver) suffers from Age-Related Macular Degeneration and started receiving the intravitreal injection since end 2015. In his interview, he shared that since the nurse started performing the intravitreal injections in January this year, it took only 10 minutes to complete the procedure after seeing the doctor.
He said: "In the past when I came for my injections, I will end up waiting outside with a large group of patients and many were unhappy. Back then, I waited for almost an hour, but I was willing to wait as I wanted to preserve my eyesight. Now that they have changed the model of care, patients are the happiest because there is no need to waste time waiting for the doctor."
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