2886 A Quality Improvement Curriculum for First Year Gastroenterology Fellows Associated With Improved Efficiency in the Endoscopy Unit

Abstract

INTRODUCTION: A teaching endoscopy unit is a dynamic setting, with many interrelated parts. Its fundamental mission is to provide quality care to patients while facilitating the development of physician learners. This requires that teaching cases be safe and effective, but also timely. We implemented a Quality Improvement (QI) curriculum in the Salt Lake City Veterans Affairs GI Endoscopy Unit with a focus on workflow efficiency. METHODS: We implemented a year-long quality improvement curriculum in the Endoscopy Unit. This was carried out by rotating first-year fellows and faculty mentors with input from technical and nursing staff. Initial efforts were aimed at identifying areas of inefficiency. Pre-intervention data was collected from fifty eight appointments over three months using recording sheets. Time points were noted as patients underwent each phase of their GI procedures with moderate sedation (e.g. appointment, check-in, intake, consent, in-room, scope in). Forty three appointments were analyzed, while fifteen were incomplete and were omitted. Our primary measure was patient check-in time to patient in-room time. Procedures were defined as “on-time,” only if this interval was thirty minutes or less. After data collection confirmed our perceived area of inefficiency, we made formal modifications to process inputs and quantified their effect over two months. A total of thirty six appointments were included in the post-intervention analysis. Eight appointments were incomplete and were omitted. RESULTS: At the time of initial data collection, a total of 14% of procedures began “on-time.” We considered multiple changes to workflow inputs. These included modifications to the check-in process, variations in the order and location of consent, utilization of workstations-on-wheels as well as novel communication methods between Unit staff. However, the chosen intervention was a formal posting which detailed the roles and responsibilities of each member of the Endoscopy Unit. This was communicated with the support of departmental leadership. Post-intervention, a total of 61% procedures began “on-time.” Overall, the initiative was associated with a 47% improvement over a five-month period. CONCLUSION: Increasing emphasis is being placed on healthcare efficiency and productivity, even in the academic setting. In this collaborative initiative, we demonstrate that implementation of a first year fellows QI curriculum is associated with a significant improvement in the timeliness of endoscopic procedures.