Improving operational efficiency in endoscopy units: A multi-domain narrative review

Endoscopy units are faced with increasing procedural demand; while staffing, space, and budgets are not. Lasting gains in efficiency rarely come from a single intervention; rather, they come from working on several fronts at once, from unit design and scheduling through to staffing, sedation choice, technology, and quality governance. We set out to bring the evidence on this for the working endoscopist, or unit manager can use. We conducted a narrative review of the literature published between 2000 and 2025, searching PubMed, Embase, and the Cochrane database with terms including "endoscopy efficiency," "endoscopy scheduling," "endoscopy quality improvement," "Lean endoscopy," "plan-do-study-act (PDSA) endoscopy," and "endoscopy key performance indicators (KPIs)." We supplemented this with consensus statements and quality measures from the American Society for Gastrointestinal Endoscopy (ASGE), the European Society of Gastrointestinal Endoscopy (ESGE), and the British Society of Gastroenterology (BSG). Eight inter-related domains were identified: meaningful KPI measurement, physical design that supports patient flow, evidence-based scheduling, lean and PDSA-driven workflow change, staffing models matched to case mix, procedure-level sedation choices, targeted technology, and quality benchmarking. In individual published series, reported gains are substantial: PDSA-based interventions increased procedural volume by up to 18% and reduced mean first-case delay by 15.5 min. Lean redesign can reduce room turnover from 28 to 18 minutes and daily cases per room from 9 to 12. Scheduling optimization can improve room utilization from below 70% to above 85% in published quality improvement series. Endoscopy efficiency needs careful metric selection, a layout that improves patients, experience, intelligent rostering, ongoing process work, flexible staffing, sensible sedation, the right technology in the right places, and honest benchmarking. The frameworks set out in this review are intended to give units of any size a starting point.