Impact of First-Case Start Time on Interventional Endoscopy Unit Efficiency at a Tertiary Academic Medical Center

Abstract

Introduction: First-case start time is an outcome measure that has been traditionally used to evaluate time management and efficiency in the surgical operating room. With the increasing demand of endoscopic services in recent years, this model has been adopted to assess efficiency in the GI endoscopy unit (EU). The aim of this study was to evaluate the impact of first-case start time on the interventional endoscopy unit efficiency at a tertiary academic medical center. Methods: The prospectively collected operational performance data (6-month period) of the interventional endoscopy rooms (rooms 1 and 2) in our unit was analyzed. As per hospital mandated policy, Firstcase start time (FIRST) delay was defined as any time the first patient of the day entered the endoscopy room after the scheduled time. We assessed the impact of FIRST delay on room throughput, which was defined as the total number of patients who underwent endoscopic procedures per room/day. The FIRST on schedule group (FIRST-OS) included all patients who underwent procedures on days in which FIRST was not delayed, whereas the FIRST delayed group (FIRST-D) represented all patients who underwent procedures on days in which FIRST was delayed by any time after the scheduled time. A subgroup analysis was performed comparing FIRST-OS with the group of patients who underwent procedures on days in which FIRST was delayed more than 15 min from the scheduled time (FIRST-D15). Results: One thousand four hundred eight patients (52.5% male; mean age 61±15) underwent a total of 1,543 procedures. FIRST was delayed in 60% (154/256) cases by an average of 15.6 (range 1-74) minutes. Patient baseline characteristics were similar between the three groups (Table 1). Room throughput was not statistically different between FIRST-OS (5.6±1.6) and FIRST-D (5.4±1.6). In the subgroup analysis of FIRST with a delay >15 minutes, the mean delay was 33.1 (range 16-74) minutes. The room throughput was significantly lower in the FIRST-D15 group (4.94±1.6) when compared to the FIRST-OS group (5.57±1.6) (p<0.0001).Table 1Conclusion: First-case start time (FIRST) delays less than 15 minutes did not significantly impact room throughput. Alternate or additional potential process measures may be more effective than FIRST delay alone for assessing efficiency in the EU.