Optometric Management Tip # 171   -   Wednesday, April 27, 2005
A Pretesting Protocol

Iíve written many times about the value of delegation in a practice. You simply canít build a big, successful practice without it. While there are many ways to delegate the pretesting phase of an eye exam, I thought I would share the system Iíve used in my practice for many years in case it may spark an idea for how you can refine your delegation protocol. Virtually all optometrists delegate to some degree, but taking a step up from wherever you are on the delegation scale will certainly increase productivity in your practice. It doesnít matter if you donít have enough patients to keep you fully busy; be efficient first.

Job Descriptions

The optometric technicians in my practice are all cross-trained to be competent in clinical pretesting as well as optical dispensing. This cross-training is an advantage in giving the practice flexibility to send an employee to the area where he or she is needed most, and it prevents boredom burnout because the staff member performs a variety of duties. Of course, these techs are also competent in contact lens assisting and special diagnostic testing.

The routine in my practice is somewhat unique in that a single technician works with a patient from the beginning of the exam to the very end of the visit, and virtually never leaves the patientís side. A nice bond is formed between tech and patient, and the patient is never left alone.

In addition to the optometric technician job title, we also employ opticians (who are only stationed in the optical and do not perform clinical work), as well as business office personnel/receptionists, optical lab technicians and an office manager. We have four optometrists in our single location office.

Pretest Room

A typical exam appointment would proceed as follows. A technician calls the patient in from the reception room, introduces herself and explains that she is assisting Dr. ________ today. The tech is trained to be friendly first and to explain the nature of each test as she goes along.

The first stop is a pretest room, which contains four instruments on a rota-table. We currently have two of these rooms, and we are seeing the need for a third. The technician is trained to move in and out of this room quickly, because it can be a bottleneck for other patients who are waiting to be called in, so chit-chat is kept at a minimum and case history is done later. The tests performed in the pretest room are: Diagnostic Imaging

The patient is escorted to a special testing room, and non-mydriatic digital retinal photography is performed. If the patient wears contact lenses or expresses an interest in them, corneal topography is also done.

Exam Room

The patient is taken to an exam room by the technician, where the technician conducts additional work before the doctor arrives. Each doctor works out of two or three exam rooms, so itís efficient to perform more pretesting here while the doctor is seeing another patient. Doctorís Session

The technician remains in the exam room during the doctorís portion of the exam. She has a workstation at the end of the refraction desk and remains quiet, recording new information while the doctor and patient talk. The tech completes all aspects of the paperwork, some of which can be done in advance during testing procedures, such as all entries on the superbill (including coding, fee entry and recall date), all copies of prescriptions to be written out, and insurance worksheets, if any. She scribes the exam data as dictated verbally by the doctor and she listens to the doctor/patient consultation so she can carry out the treatment plan agreed upon. Possible actions for the technician include:
Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management