By Sharon Woodworth / Special to Healthcare Facilities Today

At some point in our lives, each of us will experience a change in vision. With a boom in aging demographics worldwide, ophthalmology has become a rapidly growing medical field. According to the Advisory Board, ophthalmology is one of the largest growing healthcare services and, in 2015, North America accounted for the largest share of the global ophthalmology devices market. 

As healthcare facilities across North America work to keep up with the latest technological advances and build new ophthalmology facilities, there are several factors that both healthcare facility operators and designers should keep in mind. 

The day-to-day operations of an ophthalmology facility are much like a dance. Seeing into a patient’s eye requires more than the simple one-two-three sequence of arrival, exam, and discharge. A series of rooms and a progression of steps must all be choreographed for efficient diagnosis, benefiting both patient and provider. 

Adding to this complex rhythm is the variation in ophthalmic specialties where the composition of rooms and diagnostic steps can vary significantly. The playbill for ophthalmology can encompass eight subspecialties, and this article will focus on the operational steps designers need to consider for quality eye care across all specialties.

Address the challenges of patient flow

This unique choreography poses a challenge when it comes to designing ophthalmology facilities. Setting the stage for a successful facility can entail many different room types and these rooms can be grouped into four functional categories: waiting, consultation, diagnostic and exam. 

Waiting and consultation tend to be “soft” spaces because they house less medical equipment, while diagnostic and exam rooms are heavily dependent on medical equipment, more so than in any other outpatient specialty. Waiting functions include not just post-reception, pre-clinic waiting, but also alcoves and rooms strategically dispersed throughout the clinic proper for sub-waiting between diagnostic procedures or treatments. 

Diagnostic functions have a wide range starting with the initial intake to testing, which can entail simple colorblind tests to more invasive measurements such as electrical stimulations; diagnostic imaging can be as diverse as measuring the visual field to ophthalmic computerized tomography; and finally, diagnostic optometry provides a benchmark for visual acuity when needed. 

Exam rooms can accommodate many of these functions from waiting and diagnosis to exam and consultation depending on the exam room configuration and a clinic size limited to only a few rooms. Consultation functions focus on person-to-person activities such as surgery scheduling, pre-op preparation, post-op observation and discharge consultation.

The arrangement of exam and diagnostic rooms need to accommodate a smooth back-and-forth for patient and staff. If necessary, waiting as a function can happen in any room type, but offering a separate waiting area as a room in itself gives patients a sense of progression in what can sometimes be a long visit. 

These sub-waiting areas are ideal for medications to take effect, such as eye injections or drops for desensitizing or dilating the eye, and can also serve as holding areas for either pre- or post-diagnostic procedure. 

In any clinic, exam rooms are the most replicated rooms and their configuration will set the standard for clinic modularity. Diagnostic rooms vary the most in terms of medical equipment and functional need, but a highly efficient clinic will find a common module that aligns with the standard exam room. 

In general, the diagnostic functions of intake and testing can easily be combined into one room setup for both. Exam rooms and diagnostic rooms can then be identical in size, shape, and layout and may even house the same equipment; it is how the room is used that classifies it as an exam or diagnostic room. Diagnostic rooms accommodate initial eye screening generally undertaken by visual technicians, while exam rooms offer the option for follow-up testing by the physician and lengthier eye exams with medical consultation. 

Keeping these two  room types similar in shape and layout will allow the clinic to flex up and down with patient volumes and  accommodate a variety of ophthalmic specialties where testing may be minimal and exam consultation may be more involved or vice versa.  

Incorporate light and color

At some point in an ophthalmology visit every patient will have limited vision depending on the exam, treatment, or procedure; taking the stance that any patient may be “blind” requires the designer to set the stage for all patients to be safe. Ophthalmology practices should consider the following: 

● Uninhibited spatial arrangements that allow for numerous people moving from room to room; this includes wider hallways and unimpeded furniture layouts

● High contrast furniture and fixture color schemes; this includes a sharp contrast between furniture and carpet, door frames and wall color, as well as higher contrast cues near balcony edges

● Strategically placed natural light; some procedures require natural light for part of the intervention, while other procedures require a no-light, black-out condition; patients receiving dilation, need to be shielded from natural or artificial light glare, while staff appreciate access to natural light throughout their work day.

Consider federal and state legislation

All practitioners represent a unique culture in terms of how they work, and staffing criteria must be realistic for the ideal clinic to function smoothly. Understanding constraints such as the competitive market, number of physicians, academic affiliation, and even the training, hiring, and retention of key technicians can all influence the delivery of quality eye care.  

Local codes and labor laws can have an impact as well; for example, in California the Business and Professions' Code Section 2544 states that an assistant can only perform examinations under an ophthalmologist's or optometrist’s supervision; this means a technician will not be testing for visual acuity and is limited from using an autorefractor; therefore, locating either this testing room or the auto refractor itself impacts the clinic module and the choreography of where and when vision testing needs to take place during the patient’s visit. 

However you set the stage, a smooth progression of steps leads to a high quality patient experience. Once the basic waiting-diagnostic-exam-consultation composition is arranged, the overall clinic can be fine-tuned to fit the operational culture. Healthcare designers that take into account important factors such as patient flow, natural light as well as state and federal legislation will set themselves and their clients up for success. 

With the growing demand for the ophthalmology services, it’s an important time to be designing for this field and it’s equally important to be thoughtful to both the experiences of healthcare practitioners and patients when designing these facilities. 

Sharon Woodworth is a healthcare practice leader at Perkins + Will.