Using efficiency analysis and targeted intervention to improve operational performance and achieve cost savings in...

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.

To use the principles of operations management to establish a validated methodology for evaluating and enhancing operational performance in the endoscopy center.

Biphasic prospective study with pre-intervention and post-intervention efficiency data and analysis.

Tertiary-care referral teaching hospital.

Scheduled outpatients undergoing endoscopy.

Determination of the rate-limiting step, or bottleneck, of the endoscopy unit and reducing inefficiencies.

Staffing costs and a novel performance metric, True Completion Time (TCT).

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

This study is not directly tied to quality outcomes, and inpatient procedures transported to the endoscopy unit were not directly studied.

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.