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Introduction to Clinic an overview Welcome to the Clinic!! You are an important part of the team! Your role is vital for the eye health care of our patients. There are 4 departments: • The Front Office • The Clinic • The Optical • The Business (Back) Office It is an all-around team effort to run an optometric practice. Each department must lean on each other to deliver top quality care. In The Clinic... Patients receive medical attention through • vision correction In The Clinic... Patients receive medical attention through • vision correction, • disease diagnosis & management In The Clinic... Patients receive medical attention through • vision correction, • disease diagnosis & management, & • eye health education. In The Clinic... Patients receive medical attention through • vision correction, • disease diagnosis & management, & • eye health education. These are 3 main goals of the clinic. Sight is precious. Wewant must: We to help patients maintain their eyesight & enjoy the beautiful world • Preserve vision around them. • Provide professional medical services • Educate patients about their eye health The typical order that a patient will go through the clinic can be broken down into a simple order: START The typical order that a patient will go through the clinic can be broken down into a simple order: Call from waiting room START The typical order that a patient will go through the clinic can be broken down into a simple order: Preliminary Tests Call from waiting room START The typical order that a patient will go through the clinic can be broken down into a simple order: Special Tests Preliminary Tests Call from waiting room START The typical order that a patient will go through the clinic can be broken down into a simple order: Special Tests Preliminary Tests Call from waiting room START Doctor Examination The typical order that a patient will go through the clinic can be broken down into a simple order: Special Tests Preliminary Tests Call from waiting room Doctor Examination START Optical or Check Out The typical order that a patient will go through the clinic can be broken down into a simple order: Special Tests Preliminary Tests Call from waiting room Doctor Examination START Optical or Check Out Let’s take a closer look… Special Tests Preliminary Tests Call from waiting room Doctor Examination START Optical or Check Out STEP 1: Greeting a patient in the waiting room. Special Tests Preliminary Tests Call from waiting room Doctor Examination START Optical or Check Out Greeting the Patient • The tech is responsible for greeting & escorting the patient from the reception (waiting) room. • Patients are called back by appointment time unless a special circumstance arises – i.e. an emergency. • How a tech calls a patient from the reception room is important. Greeting the Patient • Before a patient is escorted to the clinic area, the tech reviews the patient’s record & makes the necessary markings/corrections in it. • The tech prepares the patient’s exam information by: Forwarding all previous information to a new exam form or computer screen. Making sure the patient history is consistent & up-todate. New vs. Returning Patients • For NEW PATIENTS, you must gather as much information as possible. There is no new information to forward & the front receptionist should have already put all the patient’s demographic information into the computer. New patient information usually takes longer to prep than a returning patient’s information. • For RETURNING PATIENTS, you must update all information & make sure it is correct. Greeting the Patient Then, before escorting a patient from the reception room to the clinic, the tech must know how many rooms are open and how long the wait is in the ‘back.’ Greeting the Patient Use the patient record to help you deduct & identify who the patient is in the reception room. Look at the patient’s: • • • • Age Name Gender Picture … to help you find them. Greeting the Patient In other words: If the person you call from the reception room is: •14 years old •Named Lesley •A female Which of these two would you assume is your patient? Greeting the Patient Yes, a very simple and silly example … but how many doctor’s offices do you walk in where the nurse yells out your name when you were the obvious choice out of the people waiting? And they wouldn’t look at you, even when they knew who you were? A personable office will greet you by name and look you in the eye. This is the type of personable office we want to be! Greeting the Patient Once you know who the patient is, 1. 2. 3. 4. You set the tone for the exam. Approach the patient Smile Give a warm welcome Introduce yourself Greeting the Patient Remember… • A greeting is more personable when the patient is not “generically” called from the reception room. • You should approach the patient that matches the description from the patient’s record instead of yelling out the patient’s name in front of everyone in the waiting room. When escorting a patient… Also, when escorting a patient from the reception room or around the clinic, walk beside of them … not in front. … not behind. … beside them!! Too much space!! STEP 2: The Pre-Test Special Tests Preliminary Tests Call from waiting room Doctor Examination START Optical or Check Out Pre-Test Once the patient is called from reception and brought to the clinic area the tech gathers necessary information from the patient for their exam… In The Clinic... Patients will go through different screenings & tests before seeing the doctor to gather this information… … this is what we refer to as pre-test. (short for preliminary test) :defined: Pre-Test The procedure of gathering information & preparing a patient for an examination before the doctor examines the patient. Includes: • Tests • Screenings • Documentation of Necessary Info Pre-Test • Allows the doctor the necessary information to have a very thorough, yet time efficient exam with each patient. • Pre-tests are the job of an optometric technician (tech). Pre-Test • The pre-test tech is in charge of calling the patient from the waiting room, running pre-test instruments and/or special testing instruments on a patient, gathering patient histories and information, dilation drops, doing the necessary visual analyses, and other necessary steps to help the patient get ready to see the doctor. • The tech must listen well and be very thorough in communication. Pre-Test Consists Of… • Fact-Finding Instruments • Case Histories • Dilation Drops • Visual Analysis • Other Preparation This slideshow does not go into great detail for each of the above; it gives an overview. For more info see individual slideshows on each topic. Pre-Test Consists Of… •Fact-Finding Instruments • Case Histories • Dilation Drops • Visual Analysis • Other Preparation A Note for Contact Lens Patients • BEFORE PRETEST: Patients who are wearing contact lenses must remove their contact lenses before doing any pre-tests! (Unless your doctor specifies otherwise). • Go over the importance of a back-up pair of glasses if the patient does not have a pair. Fact Finding Instruments • The tech is responsible for running the different instruments on each patient in pre-test. Fact Finding Instruments • The pre-test consists of instruments such as the Autorefractor Fact Finding Instruments • The pre-test consists of instruments such as the NCT (non-contact tonometer) Fact Finding Instruments • The pre-test consists of instruments such as the Retinal Photo Pre-Test Consists Of… • Fact-Finding Instruments •Case Histories • Dilation Drops • Visual Analysis • Other Preparation Case Histories • After the pre-test instruments, the tech will gather the patient’s case history. This is where you find out the patient’s current status of health and their past health history. • This can either be in the same room as the pre-test instruments or in an exam room. • The tech is responsible for escorting the patient to an exam room when the patient needs to be there (whether before or after the case history). • The doctor and/or head technician will determine where your office does case histories and in which order of the exam they fall. Case Histories • The purpose of gathering a patient’s history is to help the doctor gather as much info as necessary to help the patient save the doctor time during the exam help in communication between the patient & doctor Case Histories Case histories include the patient’s: • • • • • • • Personal history Family history Social history Chief complaint Medications Review of systems And other things your doctor may require Case Histories There is a slight difference between gathering histories for returning patients verses gathering histories for new patients. • If the patient is a returning patient, the tech should review the patient’s history with them by asking them questions about history info already gathered. • Whereas with new patients the tech must start with no previous info, thus, taking longer to gather the history. Case Histories During histories, it is imperative that the tech explains to the patient the three things that contribute to poor eye health: • Poor Nutrition • Sun Damage • Smoking These 3 factors are the basis of the Preventative Eye Care system. Pre-Test Consists Of… • Fact-Finding Instruments • Case Histories •Dilation Drops • Visual Analysis • Other Preparation Dilation Drops When a tech places eye drops in a patient’s eye, they should explain what the drops are for & explain what they are doing. Dilation Drops The tech can give a simple explanation like the following: “Let’s slip your glasses off and rest them on the table right here. Here is a tissue for blotting. I have some dilating drops to make your pupils open more so that the doctor can get a good look at the back of your eyes; these drops may sting a little. “I would like you to look way up high for me, all the way to the ceiling. You are going to feel my finger right under your eye; there is the first drop and here is the second. Keep your eyes closed and blot whenever you need to – but don’t rub.” Dilation Drops • It is okay to tell the patient that the drops will sting a little. • It is important that the patient should “blot” – not rub – their eye(s). • Dilation drops usually last about 4 hours & cause light sensitivity, so sun protection is needed when the patient leaves. Pre-Test Consists Of… • Fact-Finding Instruments • Case Histories • Dilation Drops •Visual Analysis • Other Preparation Visual Analysis Visual Analysis consists of small visual screenings that give greater insight to what the patient needs. These analyses may include: • • • • • Visual Acuity Color Vision Extraocular Muscles (EOM) Fusion Tests Confrontational Visual Field Pre-Test Consists Of… • Fact-Finding Instruments • Case Histories • Dilation Drops • Visual Analysis •Other Preparation Other Preparation • Get the computer ready for the doctor. • Set the phoropter. • Clean the equipment with alcohol wipes. Other Preparation • Notify the doctor through the light/flag system that the patient is ready for the exam. • Be honest with the patient about real waiting time & office flow. Other Preparation • To a new patient say something like: “The doctor is with another patient, but will be in here to see you soon. He is a good doctor; I think you will like him.” • To a returning patient say something like: “The doctor is with another patient, but will be in here to see you soon.” Other Preparation A refracting tech may refract the patient before the doctor sees them. If so, they will come in after the tech has done all pre-tests & the case history. STEP 3: Special Tests Special Tests Preliminary Tests Call from waiting room Doctor Examination START Optical or Check Out Special Tests • Special tests are done to detect & monitor eye diseases & to assist the doctor in maintaining the optimum health of patient’s eyes. • The doctor determines when a patient should have a special test run & will usually schedule the patient to come in for a specific appointment to do the testing. Special Tests • Special tests have their own appointment allotment. • A special test is done before the doctor sees the patient & is sometimes considered part of the pre-test procedures. Special Tests Special tests include Visual Fields OCT HRT or GDx Spectrometer Retinal Photo Special Tests Special tests include Visual Fields Special Tests Special tests include OCT Special Tests Special tests include HRT or GDx Special Tests Special tests include Spectrometer Special Tests Special tests include Retinal Photo STEP 4: The Doctor Examination Special Tests Preliminary Tests Call from waiting room Doctor Examination START Optical or Check Out Doctor Examination • The doctor medically analyzes the patient’s situation & makes a medial diagnosis from the pre-tests & personal observations. • The doctor clearly explains the patient’s situation & gives the proper care & treatment based upon medical expertise. Doctor Examination Generally a doctor’s exam will include: • Review of the patient’s case history • Slit lamp exam • Goldman Tonometer • Indirect Ophthalmoscope • Refraction STEP 5: Leading the patient out of the exam. Special Tests Preliminary Tests Doctor Examination Optical or Check Out Call from waiting room START Finalization of the Exam • At the end of an exam the patient is escorted from the exam room to either the optical or check-out – depending on what they need. • The patient is always escorted out & a hand-off is always made to the next department. – A hand-off includes summarizing what the doctor prescribed or said. – Making sure your co-employee understands what to do next & what has already been covered. Finalization of the Exam Final Notes: Efficiency and education of the patient are the keys to success as a technician. • The tech must be efficient so that the doctor can give the best possible care while servicing the optimal amount of patients. • The tech has the responsibility to educate each patient so that they will have the necessary information to take care of their eyes.
