COVID-19 has brought about a new set of norms in most fields, eyecare notwithstanding. Dr Umang Mathur, Executive Director and Cornea Consultant, Dr Shroff’s Charity Eye Hospital, New Delhi, shares how eyecare providers, along with other health services, now have to work out how care should be delivered amidst the pandemic
In 2008, Orbis and Dr Shroff’s Charity Eye Hospital embarked on a journey to achieve quality in healthcare systems. Today, the hospital has a fully functional Quality Resource Centre that has implemented a Comprehensive Institutional Quality Management System to monitor and continuously improve all aspects of eyecare service delivery. Safety of caregiver and receiver, as well as infection control within the hospital, are the critical elements of the Quality Management System. In these difficult times, the established process and framework put in place is helping us better adapt to COVID-19 response.
In the current scenario, three things are at priority:
- Safely providing urgent or emergency care and ensuring continuity of care for patients
- Protecting the healthcare workers
- Reducing the risk of virus transmission among patients
Keeping these in mind, we have made certain changes to the way we function in this ‘new normal.’
Hospital environment
The primary concern is to make sure that we don’t bring pathology inside the facility. We have made handwashing, masks for patients and attendants as well as thermal screening mandatory at the entry point. Besides this, the patient fills up a declaration form that lists symptoms to access health risk and personal information such as name and number for contact tracing if need arises. If we see or find anything out of the normal, we have protocols in place to deal with the situation. For instance, red eye or conjunctivitis could be a symptom of COVID. In this case, we have a readymade prescription of medication along with instructions to address COVID symptoms that is handed over to the patient right then.
At the Out Patient Department (OPD), we have changed the patient flow, created multiple waiting areas to avoid crowding, implemented infrastructural changes like glass partition and PA system at the registration desk and put markers to make sure people always maintain social distancing. Assuming every patient is infected, we take universal precaution while examining patients such as having PPE for the doctor, acrylic sheet on the slit lamp for barrier and cleaning the tonometer after every use, among others. Additionally, patients are asked to wear masks at all time and advised to not speak while on slit lamp, where the doctor and the patient are in proximity. Furthermore, floor/surface including knobs and railings are cleaned with one per cent sodium hypochlorite every two hours and moderate risk areas thrice a day.
Similarly, there are specific SOPs for in-patient management such as spacing between beds and the operation theater such as 20-25 minutes between each surgery to enable air exchange while the HEPA filter and air conditioning are still on. We are also conducting COVID tests via designated labs where patients undergo surgeries that generate aerosols or are administered general anesthesia.
Teams
We have also split the hospital into three teams which follow the roster system for different days of the week. We encourage no overlaps here – so that, in case one team is compromised, we know that the other two teams are clean and can take over.
Challenges and opportunities while coping with the crisis
It’s true that many healthcare facilities are facing a ‘Triple Whammy’. Increased expenses incurred due to new investments such as on PPE, decreased revenue due to shutdown of regular procedures and elective surgeries as well as decline in demand due to fear among patients in visiting a healthcare facility.
However, they also say that a crisis should never be wasted. Many of the procedures that we follow today emerged in the early 80s. HIV compelled us to modify the way we work, universal precautions became the norm. Similarly, COVID can be an opportunity to inculcate safe hospital practices and bring about behavioural changes such as handwashing.
That said, a key enabler for change will continue to be technology.
Let’s look at a scenario. One of the patients who underwent a retina surgery few months back now develops some discomfort in the eye. The patient has a teleconsultation with me. I have her entire medical history in front me, thanks to our Electronic Medical Record. I then request her to send me an image of the eye via phone messaging. I remotely diagnose her condition and prescribe a medication. The whole exercise is contactless. I foresee the same being replicated at the vison centre increasing access to eyecare for the vast majority in urban poor and the rural masses.
I see a major shift in the way we experience healthcare in the future. Healthcare technology like telemedicine is already showing promising results and has the potential to become a permanent reality.