Using efficiency analysis and targeted intervention to improve operational performance and achieve cost savings in the endoscopy center

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• 作者：Neal K. Kaushal ; MD ; MBA¹ ; ; Kenneth Chang ; MD ; FACG ; FASGE² ; John G. Lee ; MD² ; V. Raman Muthusamy ; MD ; FACG ; FASGE¹
• 关键词：CDDC ; H.H. Chao Comprehensive Digestive Disease Center ; MAC/GA ; Monitored anesthesia care/general anesthesia ; TCT ; True Completion Time
• 刊名：Gastrointestinal Endoscopy
• 出版年：April, 2014
• 年：2014
• 卷：79
• 期：4
• 页码：637-645
• 全文大小：988 K

文摘

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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聽< .001), and TCT was reduced by 12.2% (P聽< .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.