17 - Impact of Time-Motion Patient Flow Analysis on the Productivity of an Endoscopy Unit in a Large Safety-Net Health Center

Christopher P. Bradley, MHS, MD¹, Matt Sumethasorn, MD², Hyun Jin Yim, MD², Megan Chang, RN¹, Leslie Martinez, MSN-Ed, RN¹, Wei-An (Andy) Lee, DO¹, Rachel Baden, MD¹, Hal Yee, MD, PhD³, Behrod Katebian, MD¹, James L. Buxbaum, MD^4
1Los Angeles County University of Southern California Medical Center, Los Angeles, CA; ²University of Southern California Keck School of Medicine, Los Angeles, CA; ³Los Angeles County Department of Health Services, Los Angeles, CA; ⁴Keck School of Medicine, University of Southern California, Los Angeles, CA

Introduction: The COVID-19 pandemic disrupted health care delivery, particularly for high-volume procedural areas. To improve productivity in the Los Angeles County + University of Southern California Medical Center (LAC+USC) Endoscopy Unit, we initiated an iterative rapid cycle quality improvement process to identify inefficiencies and implement changes to our workflow.

Methods: A time-motion analysis of patient flow through the LAC+USC Endoscopy Unit was used to construct a time-tracked flow sheet to track individual patients as they moved through the Unit. Data were collected weekly over three 9-10 week phases, and intervening plan-do-study-act (PDSA) cycles were conducted to direct interventions for subsequent phases. Following phase 1 (9/1/21 – 11/9/21) we implemented targeted interventions at the start of phase 2 (12/1/21-2/1/22) and phase 3 (3/15/22 – 5/31/22). Phase 2 was focused on our anesthesia supported endoscopy room which requires greater resource coordination. Metrics were compared to published benchmarks. Linear regression was used to compare outcome parameters for the lean process flow improvement project.

Results: Our phase 1 analysis showed operational delays in room turnover time for all procedures and pre-operative assessment and first-case on time start percentage for procedures supported by anesthesia, when compared to published benchmarks (Table 1).

In phase 2 we implemented an intervention of combining pre-anesthesia visits with endoscopy teaching visits for patients designated to have anesthesia support. This significantly improved both turnover time and throughput for the anesthesia room (Table 1).

In phase 3 we initiated a policy of preparing the first patient of the day in the procedure room which dramatically increased first-case on time start percentage. We further streamlined inter-procedure processes by simultaneously consenting, placing monitoring equipment and documenting in the time between procedures, leading to a greater than 20% increase in total procedure volume (Table 1).

Procedure throughput for the anesthesia supported procedure room increased from 4.5 to 7 to 9 procedures per room per day for phases 1, 2, and 3 respectively (Table 1). Endoscopy Unit staffing remained unchanged throughout the study period.

Discussion: Time-motion analysis of patient flow may be used to perform targeted interventions with significant improvements in Endoscopy Unit efficiency. This may be achieved without costly interventions such as hiring additional support staff or faculty



Disclosures:


Christopher P. Bradley, MHS, MD¹, Matt Sumethasorn, MD², Hyun Jin Yim, MD², Megan Chang, RN¹, Leslie Martinez, MSN-Ed, RN¹, Wei-An (Andy) Lee, DO¹, Rachel Baden, MD¹, Hal Yee, MD, PhD³, Behrod Katebian, MD¹, James L. Buxbaum, MD⁴, 17, Impact of Time-Motion Patient Flow Analysis on the Productivity of an Endoscopy Unit in a Large Safety-Net Health Center, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.