547 Increasing Endoscopy Unit Efficiency: It's Time to Take Control

Abstract

INTRODUCTION: Operational flow is an important factor in relation to efficiency in an endoscopy center. There are opportunities for improvement in efficiency while keeping the standards of quality. We performed a time flow analysis in our outpatient endoscopy center to identify workflow improvement opportunities. METHODS: We evaluated 616 patients who underwent EGD and colonoscopy. We analyzed preop prep time, procedure time, room turnover, recovery room time, total time in unit, and physician arrival time. These times were compared to efficiency benchmarks identified in the limited literature available. A process map was documented to illustrate patient flow and to assess redundancies and non-value added steps (Figure 1). Post-intervention data was collected on 381 patients. RESULTS: Pre-procedure nursing time exceeded benchmark intervals for both EGD and colonoscopy (Table 1). This was due to lack of documentation if the patient could not be reached during precall assessment 5 days prior to procedure requiring the nurse to obtain the information on the day of endoscopy. 2/3 of nurses did not have EMR access to be able to chart the medical history prior to patient arrival. In addition, IV was placed prior to the restroom visit delaying procedure start time while physician was ready to proceed. Doubles were allotted only 30 min block times and progressive delay was noticed increasing pre-procedure wait time. Physician start time was delayed 26% by an average of 12 min (Figure 2). This was due to clerical tasks, staff questions, and operational tasks. Encounter forms were reformatted to be user friendly for nursing documentation. All nurses were given EMR access in the event where patient was not reached prior to procedure. Pre-call assessment changed from 5 to 7 days prior to procedure to increase probability of reaching patients. Patients were offered restroom break prior to IV placement. Block times for doubles were extended from 30 to 45 minute block times . Recovery room delays with EGDs were attributed to oversedation by a single nurse anesthetist who was educated regarding propofol usage. Physician delays remained essentially unchanged (Figure 2). CONCLUSION: With our interventions, we reduced pre-procedure time by 8 mins for EGDs and 7 minutes for colonoscopy. We improved recovery room time. Delays related to physician behavior remain unchanged. Our next step is to address physician arrival times will be to post results of physician start times on a weekly basis at our endocenter.