A Patient Flow Analysis: Identification of Process Inefficiencies and Workflow Metrics at an Ambulatory Endoscopy Unit

Abstract

Background. The increasing demand for endoscopic procedures coincides with the paradigm shift in health care delivery that emphasizes efficient use of existing resources. However, there is limited literature on the range of endoscopy unit efficiencies. Methods. A time and motion analysis of patient flow through the Hotel-Dieu Hospital (Kingston, Ontario) endoscopy unit was followed by qualitative interviews. Procedures were directly observed in three segments: individual endoscopy room use, preprocedure/recovery room, and overall endoscopy unit utilization. Results. Data were collected for 137 procedures in the endoscopy room, 139 procedures in the preprocedure room, and 143 procedures for overall room utilization. The mean duration spent in the endoscopy room was 31.47 min for an esophagogastroduodenoscopy, 52.93 min for a colonoscopy, 30.47 min for a flexible sigmoidoscopy, and 66.88 min for a double procedure. The procedure itself accounted for 8.11 min, 34.24 min, 9.02 min, and 39.13 min for the above procedures, respectively. The focused interviews identified the scheduling template as a major area of operational inefficiency. Conclusions. Despite reasonable procedure times for all except colonoscopies, the endoscopy room durations exceed the allocated times, reflecting the impact of non-procedure-related factors and the need for a revised scheduling template. Endoscopy units have unique operational characteristics and identification of process inefficiencies can lead to targeted quality improvement initiatives.

Factors associated with oesophagogastric cancers missed by gastroscopy: a case–control study

“…In the UK centres, Bryce et al 32 reported that in 169 patients across 43 endoscopy lists, mean turnover time per patient was 20.8 min and Edmondson et al 33 reported a similar turnover time of 20 min, after implementing nurse-led consent and intravenous cannulation 32 33. In Ontario, Canada, where conscious sedation is used routinely, the patients spend on average a total of 23 min in the endoscopy room before and after the procedure 34. Therefore, further increase in endoscopy activity might be achieved by improving workflow efficiencies and reducing turnaround time, without having a negative impact on examination time.…”

Secondary use of electronic health record data for clinical workflow analysis

“…Time-motion methods can provide data about clinic workflows, but are resource-intensive and prohibitive for large-scale studies. [9][10][11] Automated tracking and data-collection methods, such as radiofrequency identification tagging, can provide large-scale data, but are costly and difficult to implement. [12][13][14] One promising approach for studying workflow is to use the vast amount of timing data currently available in EHR systems, through timestamps recorded in audit logs during routine use.…”

Health services in Trinidad: throughput, throughput challenges, and the impact of a throughput intervention on overcrowding in a public health institution

“…Throughput at this institution is clearly suboptimum, with major gaps existing in important throughput processes, such as pharmacy, lab, and radiology services (Tables 4 , 5 , and 6 ). Throughput services, such as pharmacy [ 42 ], radiology [ 43 ], clerical [ 44 ], and lab services [ 45 ] as well as patient flow [ 46 ], are major determinants of hospital efficiency [ 47 , 48 ]. As such, throughput optimisation would naturally increase efficiency [ 49 , 50 ].…”