Albert Do, MD, MPH, Mubarak Sayyar, MD, Jared Macklin, MD, Mindy Lee, MD, Jonathan Pourmorady, MD, Amir Masoud, MD
Yale University School of Medicine, New Haven, CT
Introduction: With the ongoing focus on value-based care, there has been greater emphasis on efficiency and cost-effectiveness of health services, including gastrointestinal endoscopy. Endoscopy unit optimization requires coordination of many providers, staff, equipment, and resources. We aimed to develop a value-stream map for performance of endoscopic procedures performed at a tertiary academic medical center, identify processes associated with delays, and assess if workflow process improved after recent redesign efforts were initiated.
Methods: Data were extracted from 13,663 endoscopic procedures from January 1st, 2018 to April 1st, 2019, at the Center for Advanced Endoscopy (CAE), a 5-room gastrointestinal and pulmonary endoscopy unit. The endoscopy workflow process was mapped (Figure 1) and potential processes associated with delays (lags) identified. We isolated patient process times through the CAE and compared those before and after clinical redesign initiatives were instituted. We additionally extracted clinical characteristics and performed logistic regression to identify potential predictors of delay ≥ 30 minutes, defined as delay in processes associated with patient transportation (lag 1 or lag 3).
Results: Patient clinical characteristics (Table 1) did not differ after implementation of clinical redesign though the proportion of inpatient procedures increased (33.9% vs 37.1%, p=0.001). The rate of 30-minute delays was high and unchanged after clinical redesign implementation (25.9% vs. 25.9%, p=0.99). Delays were noted at all three potential processes: procedure room availability (19 minutes), scheduled versus actual start time (49 minutes), and awaiting transport for inpatients to return to medical ward (34 minutes). Multiple logistic regression (Table 3) revealed male gender (OR 1.09, 95% CI: 1.00-1.19, p=0.04) and inpatient status (OR 5.03, 95% CI: 4.60-5.51, p< 0.001) as significant predictors of delay in CAE workflow process.
Discussion: Patient hospitalization status is a contributing factor to delays in the CAE and. though prolonged monitoring of these patients is a logical practice, establishing benefit is needed to justify this action. Optimization of patient transportation services to procedure room and from post-procedure areas is one potential recommendation based on this analysis. This area for improvement is the center of our next optimization efforts and will be evaluated as part of this ongoing project.
Citation: Albert Do, MD, MPH, Mubarak Sayyar, MD, Jared Macklin, MD, Mindy Lee, MD, Jonathan Pourmorady, MD, Amir Masoud, MD. P2186 - WHAT'S TAKING SO LONG? OPTIMIZING EFFICIENCY IN THE ENDOSCOPY UNIT. Program No. P2186. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.