A0632 - Increasing Inpatient Endoscopy Volumes Using the Model for Continuous Improvement

Award: Presidential Poster Award

David Hudson, MD, Ziad Hindi, MD, Mohammed Alsager, MD, Christopher Lavalle, MD, Abdulaziz Alajmi, MD, Vadim Iablokov, MD, PhD, Jamie Gregor, MD, Nitin Khanna, MD, Brian Yan, MD, Karim Qumosani, MD, Mayur Brahmania,
Western University, London, ON, Canada

Introduction: Inpatient endoscopy volumes can affect patient care at many levels in a hospital system. At our academic center, inpatient procedural volume efficiency is 65% (defined as the number of completed procedures compared during the designated in-patient endoscopy time period). As a consequence, excess procedures are being completed on-call or on weekends. Our aim was to increase procedural volume by one (14%) additional procedure completed/day over a 12-month period.

Methods: An interprofessional team of Gastroenterology fellows and staff along with endoscopy nurses and managers was created to investigate throughput concerns. Baseline data was collected via direct observation and completion of a time study over 2 months. Subsequently, a process flow diagram was completed. A combination of root cause analysis tools (i.e. Ishikawa diagram and Pareto chart) were then utilized to identify areas for improvement. A delay in procedural start time was identified as a strong culprit for reduced efficiency. Potential PDSA (plan-do-study-act) cycles included: early physician handover start time, constructing a standardized patient procedure list, and improving timeliness of patient transfer to the endoscopy suite.

Results: Baseline data identified that the first case start time was delayed by 51 min when our actual start time is 08:00 am. Our first PDSA cycle involved a 15-minute earlier physician handover start time. PDSA cycle #1 reduced our mean procedural start time to 08:49 am [UCL: 104 minutes; LCL: -5.4 minutes]. Our second PDSA cycle, involved the standardization of a planned procedural list and mandate for the first procedure to be esophagogastroduodenoscopy (EGD). PDSA cycle #2 reduced start time reduced to 08:29 am [UCL: 69.6 minutes; LCL: -12.4 minutes]. Our third PDSA cycle, involved utilizing the standardized procedural list to pre-emptively organize timely patient transfer to account for delays secondary to hospital portering services, which reduced the mean start time further to 08:22 am [UCL: 52.0 minutes; LCL: -8.0 minutes].

Discussion: Using the model for continuous improvement we were able to increase procedural volumes by one (14%) per day. The most effective intervention included developing a standardized procedure list and mandating the first case as an EGD minimizing delays due to inadequate or incomplete bowel preparation.



Disclosures:


David Hudson, MD, Ziad Hindi, MD, Mohammed Alsager, MD, Christopher Lavalle, MD, Abdulaziz Alajmi, MD, Vadim Iablokov, MD, PhD, Jamie Gregor, MD, Nitin Khanna, MD, Brian Yan, MD, Karim Qumosani, MD, Mayur Brahmania, . A0632 - Increasing Inpatient Endoscopy Volumes Using the Model for Continuous Improvement, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.