A Multimodal Interdisciplinary QI Intervention Is Associated with Reduction in After Hours Inpatient Endoscopy Cases.

Area of Science:

• Gastroenterology
• Healthcare Quality Improvement
• Patient Safety

Background:

• Increasing demand for inpatient endoscopy leads to more after-hours non-emergent cases.
• Late endoscopy cases negatively impact patient safety and satisfaction for both patients and providers.
• Quality improvement (QI) methodology can address these challenges.

Purpose of the Study:

• To quantify the current state of after-hours inpatient endoscopy.
• To design and implement targeted QI interventions.
• To evaluate the effectiveness of these interventions in reducing late cases and improving efficiency.

Main Methods:

• Existing state evaluation using process mapping, time-series analysis, and caseload analysis (7/2017-12/2018).
• Prospective evaluation of a staged, interdisciplinary, multimodal intervention.
• Intervention focused on decreasing end-of-workday (EOW) after 7 PM, reducing cases begun after 5 PM, and minimizing EOW variability (post-intervention: 6/2019-2/2020).

Main Results:

• The proportion of days with EOW after 7 PM decreased from 42.4% to 29.3% (OR 0.39, p<0.001).
• Cases begun after 5 PM decreased from 17.5% to 14.2% (OR 0.75, p=0.009), despite an increased caseload.
• End-of-workday standard deviation decreased significantly, indicating reduced variability (2:20 hours to 1:36 hours).

Conclusions:

• A multimodal QI intervention effectively reduced late inpatient endoscopic procedures.
• The study demonstrates the successful application of research methods to implement QI interventions in endoscopy.
• Optimized scheduling and resource management improved efficiency and patient/provider satisfaction.