Su1271 Nonanesthesiologist Administration of Propofol Boluses vs. Continuous Infusion Plus Boluses for Outpatient Colonoscopy: A Randomized Study

Abstract

used to optimize manufacturing processes for several decades. Our aim for this pilot study was to demonstrate the value of discrete event simulation in optimizing endoscopy unit efficiency. Methods: Through a series of site visits and web conferences, we built an animated discrete event simulation model of a six-room gastrointestinal endoscopy unit at a single academic health care facility in Washington, DC. Procedures performed in the unit include colonoscopy, upper endoscopy, single balloon enteroscopy, endoscopic ultrasound and ERCP. Endoscopy unit staff electronically captured time data for the model using a commercially available software suite between January and June 2011. Simulation software was used for model creation. After validating the baseline model, we simulated a series of scenario analyses to compare the performance measures of the baseline model with the results from alternative configurations of unit flow and operational characteristics. Key outcome measures included: patient flow time from arrival to discharge; first case start time; and procedure room utilization Results: The animated simulation model is represented below in figure 1. Average patient flow time was 170 minutes. Average procedure room utilization ranged from 51%-77% and pre-op utilization averaged 44%. The first procedure of the day, scheduled to begin at 8am, began between 8:18am and 8:28am. The bathrooms in the pre-op area were identified as a bottleneck for the first cases of the day as patients waited to change prior to being prepped for their procedure. The model suggested that an 8am start time could be achieved with minor changes in unit flow, including prepping one patient in the procedure room in place of pre-op and shifting the prep time 15 minutes earlier in the morning. Conclusions: Discrete event simulation modeling is an effective tool for studying the capacity and operational efficiency of endoscopy units, which in turn may have a direct impact on improving patient experience and reducing the cost of providing endoscopic services. Further modeling efforts are underway to understand how alternative appointment schedules, staffing arrangements and patient flow patterns can optimize unit efficiency.