Boosting efficiency in the endoscopy suite: integrating team workflows improves productivity and minimizes cost.

BACKGROUND AND AIMS: Inefficiencies in the endoscopy suite cause frustration for physicians, hospital administrators, staff, and patients. Turnover time (TOT), the time between one case ending and another beginning, is subjectively disproportionate between various team members. We aimed to define perceptions of TOT and target steps within the process to improve efficiency. METHODS: This was a prospective cohort study at a tertiary center outpatient endoscopy unit. Phase I aimed to identify the TOT process components based on time stamps in the electronic medical record (N = 686). We defined gastroenterologist perceived TOT (pTOT), anesthesia pTOT, and standard TOT (sTOT). TOT length was calculated for each subgroup. Patient transport was identified as an intervenable target. In Phase II, the task of patient transport moved from the anesthesiology team to endoscopy nurses. Mean TOT and proportion of cases with sTOT <15 minutes' preintervention (n = 2192) and postintervention (n = 292) were compared. RESULTS: Seven key TOT components were identified that explain variations in pTOT. Average anesthesia pTOT was 15 minutes, whereas average gastroenterologist pTOT was 34 minutes (25.9% vs 57.2% of case length; P = .0007). In Phase II, mean sTOT improved from 18.51 to 14.25 minutes (P < .0001), and proportion of sTOT within 15 minutes improved from 41.79% to 58.90% (P < .0001). This intervention saved 45 minutes per room per day, allowing for a revenue potential of more than $300,000 per year per procedure room. CONCLUSIONS: This study defines variations in TOT and shows that finding imbalances and sharing the workload significantly cuts costs and improves the overall efficiency of the different subgroups in the turnover process.

An unusual case of gastric outlet obstruction and melena.

Strongyloidiasis is a parasitic infection caused by nematode helminth Strongyloides stercoralis. Severe infection with S. stercoralis is rare and often missed by clinicians which may cause worsen the outcomes. A 57-year-old Hispanic female with past medical history of HIV and breast cancer was transferred from an outside hospital to a tertiary care facility with complaint of persistent abdominal pain and melena. She underwent Esophagogastroduodenoscopy (EGD) twice before her presentation for the same complaints which showed severe duodenitis with multiple erosions; however, at both occasions, biopsies were deferred. A third EGD done at tertiary care hospital also revealed severe duodenitis. Another notable finding was pseudo-membranous dusky appearing mucosa with duodenal narrowing causing gastric outlet obstruction (GOO). The duodenal mucosa involved was biopsied during EGD. Pathology was consistent with Strongyloidiasis. At that time, a diagnosis of severe Strongyloidiasis causing duodenal ulceration, bleeding, and GOO was made. She was started on Ivermectin. Her hospital course was further complicated by strongyloidiasis hyperinfection syndrome (SHS) leading to her demise. Severe infection with S. stercoralis causing SHS is associated with significant morbidity and mortality. High index of suspicion, timely diagnosis and management is prudent for preventing serious complications.

The Impact of Cholecystectomy on Long-Term Disease Outcomes and Quality of Life in Patients with Crohn's Disease.

BACKGROUND: Cholecystectomy (CCY) is one of the most frequently performed abdominal surgeries. However, the impact of CCY in clinical settings with altered gastrointestinal physiology and anatomy, such as Crohn's disease (CD), has not been fully characterized. We sought to investigate clinical outcomes, disease severity, and quality of life of CD patients after CCY. METHODS: We utilized a prospective, longitudinal registry of consented CD patients followed at a tertiary center. Crohn's disease patients that had or had not undergone CCY formed the 2 study groups. The absence or presence of gallbladder was confirmed with abdominal CT scans obtained during routine care. Multiyear clinical, biochemical, and histologic data were collected and analyzed. RESULTS: Among 834 CD patients, 151 (18%) had undergone CCY. History of CCY was associated with higher disease activity (median Harvey-Bradshaw index; P < 0.001), more years with anemia (P = 0.048), lower albumin (P = 0.001), worse quality of life (mean Short Inflammatory Bowel Disease Questionnaire; P < 0.001), chronic abdominal pain (P < 0.001), higher risk for incident colonic dysplasia (P = 0.011), higher rates of annual hospital admissions (P = 0.004), and opioid use (P < 0.001). In multivariate analysis, CCY remained associated with higher disease activity (P < 0.001), lower albumin (P = 0.008), lower quality of life (P < 0.001), and more hospital admissions (P = 0.008), whereas CD patients with diseased ileum had higher risk for colonic dysplasia (P = 0.031). CONCLUSIONS: CCY in CD patients was associated with multiple markers of disease activity and worse quality of life during multiyear follow up. This data suggests that CCY in CD patients may adversely impact the long-term clinical course.