Practice Management

22 - Endoscopy and Anesthesia Efficiency and Access Project

Tuesday, October 9
9:00 AM - 9:10 AM
Location: Terrace Ballroom 4 (level 400)

Category: Practice Management
Sooraj Tejaswi, MD, MSPH1, Sital Singh, MD2, Gary Levin, MD, MBA2, Stephanie Yan, MD 2
1University of California Davis Medical Center, Sacramento, CA; 2University of California Davis, Sacramento, CA

Introduction: Our GI lab had significant wait times for EUS, ERCP, and Colonoscopy with EMR, needing anesthesia support, resulting in diagnostic delays, prolonged length of hospital stay (LOS), and increased no show rates.

Methods: Review of workflows associated with both GI outpatient and inpatient procedures revealed multiple inefficiencies.

A Pareto diagram regarding inpatient procedures revealed that inadequate prep (~1/3) was most commonly associated with delays.

On average access time for outpatient advanced endoscopies was >90 days. Delays resulted in a no show rate of 5%, which was partly also due to inadequate patient notifications. We also realized that existing anesthesia request work flow was inefficient.

A major barrier resulting in inefficiency was  asynchronous general anesthesia (GA) team and endoscopist work flow.

Transportation waste was also a major barrier as PACU (post anesthesia care unit) for recovery of sedation was~ 400 yards away, that required ~ 20 minutes to walk time.

Major intervention was implementing the two room GA model on Tuesdays and Wednesdays and synchronizing GA and endoscopist workflows.

A new recovery area within the GI lab was created to decrease transport waste.

EMR enhancements for anesthesia request, patient notifications, and new inpatient split bowel prep order-set were implemented

Outcome measures included total nubmers of cases completed, access time for procedures, bowel prep order-set utilization rate, quality of bowel prep, and time from bowel prep order to procedure as a surrogate for LOS 

Results: The GI lab throughput increased from 9 GA cases to 20 cases on Tues-Wed (124% increase). The anesthesia cases on days of the week without the two room GA model remained unchanged

Average access time for GA referrals  decreased from 78.7 days to 52.2 days (33.7% decrease). Access time for all referrals decreased from 75.6 days from 55 days (26%).

New split bowel prep order set utilization was 78%.

Time to inpatient procedure from order placement was 1 day if the bowel prep order set is used versus 1.3 days if not used. 72% of patients in the bowel prep order set group had excellent prep compared to 36% in the non split prep group.

Discussion: Adopting a DMAIC and lean process model, our multidisciplinary team of endoscopist, anesthesiologists, trainees, nurses, and schedulers significantly improved efficiency and access to cases needing GA in a busy GI Lab

Pareto diagram of causes for delayed procedures
Asynchronous Endoscopy and GA workflow
Synchronized work flow model

Disclosures:
Sooraj Tejaswi indicated no relevant financial relationships.
Sital Singh indicated no relevant financial relationships.
Gary Levin indicated no relevant financial relationships.
Stephanie Yan indicated no relevant financial relationships.

Sooraj Tejaswi

Associate Clinical Professor
University of California Davis Medical Center
Sacramento, California

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