An initial investigation of efficiency in endoscopy delivery

The demand for endoscopic services is increasing rapidly. Of the several potential mechanisms to improve the supply of endoscopic procedures, improved efficiency in the endoscopy unit has received little attention.

We invited 20 experienced endoscopists to participate in an initial evaluation of endoscopy efficiency, in which they were observed performing procedures in their own unit. Procedure volume per unit time was used as the measure of efficiency. Medical directors and head nurses at each endoscopy unit were interviewed regarding factors they perceived as most important in limiting procedure volume.

There was a greater than 3-fold variation in procedure volume score between the least efficient and most efficient endoscopists. The clearest trend predicting procedure volume score was short room turnover time (p = 0.0004). There was a trend toward improved procedure volume among endoscopists using another professional to sedate their patients and using two procedure rooms. The surveys of medical directors and head nurses suggested that multiple factors contribute to limiting procedure volume, but on average each perceived number of available doctors is the least important factor in limiting volume.

Improving the efficiency of some endoscopists appears to be an important potential mechanism to meet the rising demand for endoscopic services. Increasing the resources that provide the opportunity for efficiency may be an important mechanism for increasing the availability of endoscopic services. Specific measures associated with improved efficiency include reduced room turnover times, and possibly use of two rooms per endoscopist and sedation by persons other than the endoscopist.