HEALTH CARE WORK INCIDENT TO AMBULATORY ENDOSCOPY A MULTI-CENTER ANALYSIS OF WORK AND COST

Abstract

Purpose: A large industry has developed around the practice of endoscopy in recent years. Although broad guidelines exist for establishing endoscopy practices, regulations for ambulatory endoscopy vary dramatically among different settings resulting in variable ancillary service requirements and staff resource utilization. Ideally, procedure guidelines and related ancillary work should improve quality or safety at a reasonable cost. We searched the medical literature and could not find previous research as to whether such ancillary work achieves the above objectives. As such, we sought to investigate, characterize, measure, and compare the ancillary work associated with ambulatory endoscopy among various institutions with the ultimate hope of determining whether it improves quality and safety efficiently. Methods: We compared the work incident to endoscopy at five health care institutions in the New York City area, including a municipal hospital, a large academic medical center, two community hospitals, and an unregulated physician's private practice. At each site, we observed staff completing forms required for an endoscopy procedure as a measure of ancillary activities and services and then reviewed completed forms in patient charts to investigate and quantify the documentation requirements. Results: In the regulated facilities, the time commitment by staff to provide ancillary services ranged from about a half hour to as much as two hours, compared to five minutes at a physician's private office. The number of forms and items that required completing was also fewest at the physician's office, fairly consistent among the community hospitals and the academic medical center, and highest at the municipal hospital, with the amount of items to be filled out varying by over 80 fold (see Table).Table: Variation in Ancillary Work by FacilityIn general, we noted two types of problems: redundancy, which was most evident at the municipal hospital, and irrelevancy, which was more widespread and comprised work of questionable value in promoting safety or improving care. Conclusions: The ancillary work of ambulatory endoscopy is highly variable across different settings. We found that much of this work is also of seemingly dubious value.