Continuous Nursing Care in GI Endoscopy Improves Nurse and Room Utilization and Decreases Patient Wait Time

Abstract

Purpose: Continuous nursing care from prep through procedure has been advocated as an approach to improve nursing care and operational efficiency in endoscopy units. Our aim was to employ discrete event simulation modeling to evaluate the potential efficiency of this novel nursing paradigm as compared to the standard of care. Methods: We built an animated discrete event simulation model of an eight-room endoscopy unit at a single academic health care facility in Durham, NC. Endoscopy unit staff electronically captured time data for the model using commercially available software (Provation® MultiCaregiver). Simio® simulation software was used for model creation. The baseline model represented the current standard of care with separate nursing pools for the preparation, procedure and recovery areas. After validating the baseline model, we simulated a continuous nursing care model where a pool of nurses jointly covered the preparation and procedure areas. As patients entered the unit, they were assigned a nurse from this pool that remained with them until the procedure was completed. Because the continuous nursing paradigm eliminated a patient-handoff, we performed a sensitivity analysis to assess the impact of reducing the procedure room preparation time on operational efficiency. Key outcome measures were based on the average of 50 replications of the model and included: patient flow time from preparation start to procedure completion; nurse utilization; procedure room utilization and patient waiting time in prep for a procedure room. Results: The results of the simulation are provided in the table below. The average patient flow time in the baseline model (111.6±1.3 min) and continuous care model (110.7±1.5 min) were similar. A 50% reduction in the procedure room prep time also decreased patient wait time in prep, resulting in a 26% decrease in the average flow time to 81.1±1.1 min. Room and nurse utilization both significantly decreased as well, representing an opportunity for increased capacity.Table: [1911]Conclusion: A continuous nursing care model has the potential to improve the operational efficiency of endoscopy units and the patient experience without requiring additional nursing resources. The magnitude of this benefit will depend on the time savings from eliminating a patient hand-off. This research was supported by an industry grant. Simio LLC provided free access to their simulation software via an academic license to Duke University.