A Patient Flow Analysis: Identification of Process Inefficiencies in a Tertiary Care Endoscopy Center

Abstract

Introduction: Gastrointestinal endoscopic procedures are essential in the evaluation and treatment of gastrointestinal diseases. An aging patient population and emphasis on preventative care and surveillance have contributed to an increased demand for endoscopy. One potential approach to increase supply of endoscopy services is to improve the efficiency of endoscopy units. However, there is limited literature on the range of endoscopy unit efficiencies. The goal of this study was to identify the etiology of endoscopy delays in our endoscopy unit.Figure 1Figure 2Methods: Retrospective analysis was conducted of endoscopy suite data from April 1, 2015 through October 30, 2015 to identify the origin of delays. An observational arm further characterized the retrospective data. Results: A total of 1296 procedures were performed during this time period. Colonoscopies comprised 49% (635) of the procedures, EGD contributed 19% (244), EGD/colonoscopy 7% (85), ERCP 6% (77), upper EUS 8% (106), and upper EUS/ERCP 1% (16). All other procedures made up the remaining 10% (133). On average, the flow time (arrival to endoscopy unit to arrival in the recovery room) was 159.1 ± 63.0 min. The main bottleneck of the operation was identified as the preparation time (waiting room to procedure room) which took on average 113.9 ± 60.3 min. An additional major bottleneck was room turnover (patient exiting to next patient entering the same procedure room) with a mean turnover time of 36.5 ± 29.1 min. To isolate the exact cause of the delays within each bottleneck, a direct observation period was conducted from December 2015 to January 2016 (Table 1).Table 1: Direct observation dataLinear regression demonstrated that the flow time increased as the day progressed (r = 0.29; p < 0.05). Analysis of the variation between physicians shows that physicians have an impact on the overall flow time of the patient (p < 0.05). The type of procedure also had a significant impact on endoscopy unit efficiency (p < 0.05). Conclusion: Endoscopy units have unique operational characteristics and identification of process inefficiencies can lead to targeted quality improvement initiatives. These baseline data will be essential for future resource optimization and have identified unique opportunities for process improvement at our endoscopy center. We recommend all endoscopy units undertake efficiency analysis to determine bottlenecks and help increase patient satisfaction and decrease healthcare costs.