A "time-and-motion" study of endoscopic practice: strategies to enhance efficiency.

ABSTRACT

BACKGROUND: With the growing demand on endoscopic resources, achieving optimal efficiency has assumed increasing importance. OBJECTIVE: This study adopted a time-and-motion approach to assess efficiency in the endoscopy unit of a large teaching hospital and to identify strategies to enhance efficiency. DESIGN: Consecutive endoscopic procedures were prospectively observed over the study period, and time intervals of the individual components of each procedure were recorded. SETTING: Tertiary-referral teaching hospital. PATIENTS Consecutive patients undergoing endoscopy. INTERVENTION Prospective recording of endoscopic data. MAIN OUTCOME MEASUREMENTS Time intervals of the individual components of each procedure. RESULTS: Data were prospectively recorded for 400 procedures 197 EGDs, 123 colonoscopies, 32 flexible sigmoidoscopies, and 48 double procedures (an EGD and a flexible sigmoidoscopy or colonoscopy). Several strategies to improve the efficiency quotient (EQ), the proportion of time that the endoscopist is engaged in performing the procedure or completing postprocedure paperwork, were identified (1) employing personnel to obtain prior intravenous access and consent of patients increased the EQ by 10.8%, (2) using a 2-rooms-per-endoscopist model increased the EQ by 51.2%, (3) using personnel to both obtain consent and sedate the patient before an endoscopy increased the EQ by 30.9%, and (4) eliminating postprocedure paperwork for the endoscopist in conjunction with preconsent and sedation and a 2-room model increased the EQ by 63.3%. LIMITATIONS: Findings represent the experience of a single endoscopy unit in a tertiary-referral center and may not be generalizable to ambulatory surgical centers or other hospital-based endoscopy units. Factors other than procedure-time components may impact the efficiency of a 2-rooms-per-endoscopist model. CONCLUSIONS: A time-and-motion approach can be used to identify strategies to enhance endoscopic efficiency. The quality of any aspect of endoscopy performance should never be compromised in an attempt to enhance efficiency.