AN OPERATIONS MANAGEMENT APPROACH TO A CRITICAL ENDOSCOPIC BACKLOG

ABSTRACT

Background: The COVID-19 pandemic introduced unprecedented disruptions to healthcare delivery, particularly for ambulatory services such as gastrointestinal endoscopy. At the peak of the pandemic in our region between December 2020 to February 2021, ambulatory endoscopy services were suspended at the Los Angeles County + University of Southern California Medical Center (LAC+USC). While endoscopy services resumed in March 2021, the operational challenges introduced by COVID-19 led to a mounting backlog of patients awaiting endoscopic procedures reaching 1,035 by June 2021. As part of our solution to this crisis, we used the principles of operations management to perform a process flow analysis to identify inefficiencies and develop targeted interventions to enhance the operational performance of our endoscopy unit. Methods: A time-motion analysis of patient flow through the LAC+USC Endoscopy Unit was used to construct a comprehensive time-tracked flow sheet to track individual patients as they moved through the unit from check-in to discharge on random dates over a 6-week period (Figure 1). Simultaneously, a qualitative stakeholder survey on perceived operational inefficiencies was distributed to all faculty, staff, and fellows in the endoscopy unit. At the end of 6 weeks, collected data were compared to both published benchmarks and stakeholder survey responses, and inefficiencies identified for intervention. Results: Data were collected for 214 procedures (179 moderate sedation, 35 monitored anesthesia care) in the endoscopy unit. When compared to established benchmarks, we found operational delays in 1) check-in to procedure start time, 2) room turnover time, and 3) first-case on-time start percentage (Table 1). Results from the stakeholder survey aligned with these data. Targeted interventions (Table 1) developed by a multi-disciplinary group of faculty, nursing staff, and trainees from both Gastroenterology and Anesthesiology departments were then implemented, including 1) preparation of the first patient of the day in the procedure room, 2) pre-operative clinic visits for all patients designated to require anesthesia during endoscopy, 3) implementation of a brief-operative note and 4) a time study to encourage first-case on-time start. In combination with maneuvers to streamline the pre-procedure process, this resulted in a reduction of the backlog to 430 by November 2021. Conclusion: Granular analysis of data tracking process flow times through the LAC+USC Endoscopy Unit aligned with stakeholder perceptions regarding operational inefficiencies. The combination of objective and subjective data allowed us to rapidly implement targeted interventions to increase the throughput of the endoscopy unit and address the backlog of endoscopy procedures caused by the COVID-19 pandemic. (Figure Presented) (Table Presented)