ANALYZING AND IMPROVING ENDOSCOPY UNIT EFFICIENCY IN AN ACADEMIC TERTIARY CARE UNIVERSITY HOSPITAL

ABSTRACT

DDW 2022 Author Disclosures Armin Parsi NO financial relationship with a commercial interest ;QiQi Zhou NO financial relationship with a commercial interest ;G. Nicholas Verne NO financial relationship with a commercial interest Background: The COVID-19 pandemic required postponement of many elective gastrointestinal (GI) endoscopic procedures. With the pandemic now in control, the number of patients requiring GI endoscopic procedures has steadily increased. This increasing demand combined with a shortage of qualified support staff in the aftermath of the pandemic has made efficiency-improvement in endoscopy centers an increasingly important topic for academic medical centers. Aim: To determine strategies to enhance efficiency in an academic tertiary-care endoscopy unit. The overall goal was to decrease physician down-time and maximize the use of support staff and nurses without adversely impacting the patient or provider experience. Methods: We introduced a new metric, inter-procedure time, defined as the elapsed time between endoscope removal from one patient and endoscope insertion into the next patient, as the metric of choice to measure and track improvements in efficiency. This metric not only accounts for the time spent for room turnover but also other factors that may delay initiation of the subsequent procedure while the patient is already in the endoscopy room. In an ongoing prospective quality-improvement project, we initiated a 3-pronged intervention strategy 1) employed a “one- endoscopist-two-room” model, 2) improved nonphysician staff utilization by having a nurse rotating between two endoscopy rooms, and 3) instituted clear communication of when a procedure was close to completion in order to begin the room turnover process. Results: The inter-procedure times were prospectively measured for 100 consecutive patients presenting for elective outpatient endoscopy before the intervention and 66 consecutive patients after the intervention. Patient demographics, severity of comorbidities, and the type of endoscopic procedures did not differ between the two groups. Before the intervention, the average inter-procedure time was 36.7±21min while after the intervention the average inter- procedure time decreased to 17±9.7 min(p< 0.001). After the intervention, the number of endoscopic procedures performed per day increased by 32% without any change in the number of endoscopists or support staff. Conclusions: 1. Strategies such as one-endoscopist-two-room model, improving nonphysician staff utilization, and improved communication between providers can significantly enhance efficiency of endoscopy units without increasing costs. 2. Decreasing inter-procedure time is directly associated with increasing endoscopy unit output. Interprocedure time is therefore an appropriate metric for measuring and tracking efficiency in endoscopy units. 3. Further studies are needed to assess sustainability of these improvements in the long term. (No Image Selected)