Clinic Schedule: Tuesday All Day

Clinic Flow:

• Eight rooms on the first floor GHEI

• Patients categorized into the following

  • Blue Dot / Yellow Dot: Various meanings (disability, certain room needed, etc.), ask Liz (who knows the patients)

  • KUXFEL: Post-Op / Recent Follow-up Patients. American Fellow to see / staff with BDK

  • Regular: Other patients.

• Flag System

  • Green flag + chart in bin = Patient ready for fellow to see (after you see the patient, put the chart back in the bin and put the flags down)

  • Green flag and no chart in bin = A fellow is in the exam room seeing the patient

  • No flag + chart in bin = Patient ready for Dr. Kuppermann to see

  • Red flag = Dr. K is in the room

  • Red + Green flag = Dr. K uses this to note which room he is going to next

  • All flags up = injection has been decided, need to prep the patient for injection

  • Blue + Yellow = Technician needs to clean room

Note Guidelines:

• Very few new patients; pull note template from another patient if seeing a new patient

• Update the description of the exam based on the OCT and the actual examination

• That examination gets copied into the top section of the note and the middle section of the note

Injection Protocol: 

• Preparation

  • “Coverlet” sticker marks the eye (place on the forehead). Everyone in room gets masks.

  • One drop proparacaine, one drop ocuflox. Prep some of the tray for the next 30-60s. Repeat one drop proparacaine, one drop ocuflox.

  • Place Akten lidocaine gel in the inferotemporal fornix - do this early so it has time to work and melt

    • For the few patients that get subconjunctival lidocaine, the American fellow will do this

  • Prep the tray (see picture at right): Betadine swabs (2-3), betadine bottle, speculum, TB syringe (needle removed), large gloves, cotton tip, drug with label on it (if not PFS)

  • One drop proparacaine and ocuflox 

  • Tape the surgical mask with good seal. 

  • Computer Work: 

    • Imaging/Procedure > Injection Procedure (recommend making BDK template b/c he is the only one who uses lidocaine gel)

      • Bilateral injections are recorded separately as OD and OS, not OU

    • Imaging/Procedure > Timeout (fill out remaining information)

• Injection

  • Wash hands, put on gloves. 

    • When Dr. Kuppermann comes in, he is given priority for handwashing (try to have this done before he comes in!)

  • Wait for Dr. Kuppermann to place the last round of proparacaine and ocuflox

  • Betadine swab the lashes

  • Place lid speculum

  • 5% betadine drop

  • Mark 4 mm from limbus with TB syringe inferotemporal limbus

  • Dr. Kuppermann delivers the injection

  • Rinse the eye with eyewash, including the superior fornix

  • Final drop of ofloxacin

Clinic Schedule: Wednesday AM (Orange), Thursday PM (Irvine/Orange), Friday AM (Orange)

Clinic Flow:

• Three Rooms at GHEI or Orange

• Fast paced! Efficiency is the game here. Get her out of clinic on time to win the game.

Note Guidelines:

• Notes are very sparse and are completely cleaned out every visit - very little copying forward except for the basic problems.

• Try the following dot phrases

  • .rdprecautions

  • .areds

  • .recbsbp (diabetics and other vascular dz)

Injection Protocol: 

• Preparation

  • One drop proparacaine, wait a few minutes while prepping the injection itself

  • Subconjunctival lido-epi in inferotemporal bulbar conj

  • Leave the following for Dr. Lu: betadine bottle, injection, eyewash

  • Computer Work: 

    • Imaging/Procedure > Injection Procedure

• Injection (if you do it)

  • Dr. Lu does most of the injections herself actually! Some patient's specifically request it.

  • Proparacaine, speculum, betadine, injection, wash

Clinic Schedule: Monday All Day (Irvine), Tuesday All Day (Orange), Wednesday AM (Irvine), Friday All Day (Irvine)

Clinic Flow:

• Three or Four Rooms at GHEI or Orange

• Efficiency is the name of the game! He is typically watching you to see your pace.

  • Pre-charting is recommended!

• You can do the injections (but look at protocol below), but not on all patients (ask first)

• You will do the lasers

Note Guidelines:

• Recommend pre-charting

• His note is .ophnotemcm (for a new patient)

Injection Protocol: 

• Preparation

  • One drop proparacaine, wait a few minutes while prepping the injection itself

  • One drop betadine at the superotemporal fornix

  • Subconjunctival lido-epi in superotemporal bulbar conj

  • Leave the following for Dr. Mehta: betadine bottle, injection, speculum, eyewash

  • Computer Work: 

    • Imaging/Procedure > Injection Procedure

• Injection (if you do it)

  • Proparacaine, Speculum, Betadine, Injection, Betadine, Wash, Ketorolac

Clinic Schedule: Monday PM (Orange),  Tuesday AM (Irvine), Wednesday PM (Irvine), Thursday All Day (Orange), Friday AM (Orange), Friday PM (Irvine)

Clinic Flow:

• Three Rooms at GHEI or Orange

• Slow-paced clinic; Dr. Riazi books exactly the number of patients he can see without getting behind

• Dr. Riazi has a very low threshold for adding more laser to recently lasered patients if there is anything concerning, and is able to see through the haziest media

Note Guidelines:

• The notes can be convoluted and tell the entire story of the patient's illness - find the spot at the bottom of the problem where you can add a date and assessment.

Injection Protocol: 

• Preparation

  • One drop proparacaine, wait a few minutes while prepping the injection itself

  • Subconjunctival lido-epi in inferotemporal bulbar conj

  • Leave the following for Dr. Riazi: betadine bottle, injection, speculum, eyewash

  • Computer Work: 

    • Imaging/Procedure > Injection Procedure

• Injection (if you do it)

  • Proparacaine, Speculum, Betadine, Injection, Betadine, Wash

Clinic Schedule: Monday PM (Irvine), Tuesday AM (Irvine), Thursday All Day (Orange)

Clinic Flow:

• Three or Four Rooms at GHEI or Orange

• Relatively fast-paced with interesting problems

Note Guidelines:

• Dot phrase for new patients is .noteawb

• Pre-charting is helpful because its fast-paced

• Copy the entire colored-box section at the top and then update one of them for the visit that day. Add the vision in that eye and that area is just a quick summary of what's going on!

Injection Protocol: 

• Preparation

  • One drop proparacaine, wait a few minutes but dont prep the injection

  • Subconjunctival lido-epi in inferotemporal fornix

  • Leave the following for Dr. Browne: betadine swab, injection (unprepped), eyewash

  • Computer Work: 

    • Imaging/Procedure > Injection Procedure

• Injection (if you do it)

  • Proparacaine, Betadine Swab (clean pars plana and hold open lids), Injection, Roll Betadine Swab Back, Wash

Clinic Schedule: Wednesday AM (Irvine), PM (Orange), Thursday PM (Irvine), Friday AM (Orange)

Clinic Flow:

• Three or Four Rooms at GHEI or Orange

• Moderate fast-paced with interesting problems including oncology and posterior uveitis

• Bring a speaker and enjoy some Deep House

Note Guidelines:

• Dot phrase for new patients is .kmclinicnote

• Pre-charting is helpful for the new patients because they're coming with complex problems

Injection Protocol: Same as Lu