S1232 Patient Tardiness, Physician Tardiness, and Procedural Nurse Pre-Operative Workflow Drive Delays in the First and Second Procedure Start Times in a Tertiary Care Endoscopy Unit

Abstract

INTRODUCTION: As demand for endoscopy increases, there is a greater need for efficiency in endoscopy facilities. This study aims to identify workflow bottlenecks at a high-volume tertiary care center endoscopy unit at the beginning of the workday. METHODS: We mapped hospital staff workflow from the time of patient arrival to our facility to the start of their endoscopic procedure. We quantified delays to the start of the first case of the day for inpatient and outpatient endoscopy procedures from May 1, 2019 to January 31, 2020 and categorized the reasons for delay through our electronic medical record (Epic). Delays were defined as cases that started greater than 5 minutes after scheduled time. Turnaround time, defined as the period between the end of the first case to the start of the second case, was also quantified through data in our electronic medical record. RESULTS: Of the 599 first cases, 85% of inpatient (n = 25) and 73% of outpatient (n = 574) cases did not start on time. Approximately 10% of inpatient cases rolled over to the next day. The most common causes of delays in the start of the first case were patient tardiness (44%, n = 147) and GI physician tardiness (36%, n = 108) (Figure 1), translating to a mean of 35 minutes and 22 minutes of delay respectively. Within our standard workflow, the mean pre-operative time was 67 minutes. The median registration time was 17 minutes. The median total pre-operative documentation time was 50 minutes, of which 27 minutes were with nursing, 5 minutes with GI, and 5 minutes with anesthesia (Figure 2). The remaining 13 minutes were spent waiting, during which the patient was not interacting with a health care provider. CONCLUSION: At our high-volume tertiary care center endoscopy unit, more than half of our first cases of the day did not start on time. The most common factors were patient and GI physician tardiness. The pre-operative process was found to be a major cause of delay in starting the second case of the day. There are large gaps in the pre-operative window where the patient is not interacting with a healthcare provider. Further research is needed to measure the effect of planned interventions and reduce delays.Figure 1.: Documented reasons for delay of the first endoscopy case of the day.Figure 2.: Median and interquartile ranges of pre-operative times by procedural nurse, GI provider, and anesthesia provider for preparation of first and second patients of the day.