Neal K Kaushal1, Kenneth Chang2, John G Lee2, V Raman Muthusamy1. 1. Department of Gastroenterology, David Geffen School of Medicine at UCLA, UCLA Medical Center, Los Angeles, California, USA. 2. H.H. Chao Comprehensive Digestive Disease Center, Department of Gastroenterology, University of California, Irvine Medical Center, Orange, California, USA.
Abstract
BACKGROUND: With an increasing demand for endoscopy services, there is a greater need for efficiency within the endoscopy center. A validated methodology is important for evaluating efficiency in the endoscopy unit. OBJECTIVE: To use the principles of operations management to establish a validated methodology for evaluating and enhancing operational performance in the endoscopy center. DESIGN: Biphasic prospective study with pre-intervention and post-intervention efficiency data and analysis. SETTING: Tertiary-care referral teaching hospital. PATIENTS: Scheduled outpatients undergoing endoscopy. INTERVENTION: Determination of the rate-limiting step, or bottleneck, of the endoscopy unit and reducing inefficiencies. MAIN OUTCOME MEASUREMENTS: Staffing costs and a novel performance metric, True Completion Time (TCT). RESULTS: Data were prospectively recorded for 2248 patients undergoing a total of 2713 procedures (phase I: 255 EGD, 305 colonoscopy, 91 EGD/colonoscopy, 375 EUS, 44 ERCP, 75 EUS/ERCP; phase II: 243 EGD, 328 colonoscopy, 99 EGD/colonoscopy, 335 EUS, 38 ERCP, 109 EUS/ERCP). The bottleneck of the operation was identified as the 10-bed communal pre-procedure/recovery room. On-time procedure starts increased by 51% (P < .001), and TCT was reduced by 12.2% (P < .001) across all cases studied. Overtime and per diem nursing costs were reduced by 30%, whereas full-time employee staff was reduced by 0.85. Annual cost savings were calculated as $312,618 or 11.02% of total operating expenses. LIMITATIONS: This study is not directly tied to quality outcomes, and inpatient procedures transported to the endoscopy unit were not directly studied. CONCLUSION: Room turnover time and room-to-endoscopist ratio are not necessarily the driving parameters behind endoscopy unit efficiency. A focus on developing a methodology for identifying factors constraining operational efficiency can improve performance and reduce costs in the endoscopy center.
BACKGROUND: With an increasing demand for endoscopy services, there is a greater need for efficiency within the endoscopy center. A validated methodology is important for evaluating efficiency in the endoscopy unit. OBJECTIVE: To use the principles of operations management to establish a validated methodology for evaluating and enhancing operational performance in the endoscopy center. DESIGN: Biphasic prospective study with pre-intervention and post-intervention efficiency data and analysis. SETTING: Tertiary-care referral teaching hospital. PATIENTS: Scheduled outpatients undergoing endoscopy. INTERVENTION: Determination of the rate-limiting step, or bottleneck, of the endoscopy unit and reducing inefficiencies. MAIN OUTCOME MEASUREMENTS: Staffing costs and a novel performance metric, True Completion Time (TCT). RESULTS: Data were prospectively recorded for 2248 patients undergoing a total of 2713 procedures (phase I: 255 EGD, 305 colonoscopy, 91 EGD/colonoscopy, 375 EUS, 44 ERCP, 75 EUS/ERCP; phase II: 243 EGD, 328 colonoscopy, 99 EGD/colonoscopy, 335 EUS, 38 ERCP, 109 EUS/ERCP). The bottleneck of the operation was identified as the 10-bed communal pre-procedure/recovery room. On-time procedure starts increased by 51% (P < .001), and TCT was reduced by 12.2% (P < .001) across all cases studied. Overtime and per diem nursing costs were reduced by 30%, whereas full-time employee staff was reduced by 0.85. Annual cost savings were calculated as $312,618 or 11.02% of total operating expenses. LIMITATIONS: This study is not directly tied to quality outcomes, and inpatient procedures transported to the endoscopy unit were not directly studied. CONCLUSION: Room turnover time and room-to-endoscopist ratio are not necessarily the driving parameters behind endoscopy unit efficiency. A focus on developing a methodology for identifying factors constraining operational efficiency can improve performance and reduce costs in the endoscopy center.
Authors: Dennis Yang; Robert Summerlee; Alejandro L Suarez; Yaseen Perbtani; J Blair Williamson; Charles W Shrode; Anand R Gupte; Shailendra S Chauhan; Peter V Draganov; Chris E Forsmark; Mihir S Wagh Journal: Endosc Int Open Date: 2015-12-07