ABSTRACT
BACKGROUND AND AIMS: Inefficiencies in the endoscopy suite cause frustration for physicians, hospital administrators, staff, and patients. Turnover time (TOT), the time between one case ending and another beginning, is subjectively disproportionate between various team members. We aimed to define perceptions of TOT and target steps within the process to improve efficiency. METHODS: This is a prospective cohort study at a tertiary center outpatient endoscopy unit. Phase I aimed to identify the TOT process components based on time stamps in the electronic medical record (n=686). We defined gastroenterologist (GI) perceived TOT (PTOT), anesthesiology PTOT and standard TOT (sTOT). TOT length was calculated for each subgroup. Patient transport was identified as an intervenable target. In Phase II, the task of patient transport moved from the anesthesiology team to endoscopy nurses. Mean TOT and proportion of cases with sTOT <15 minutes pre- (n=2192) and post-intervention (n=292) were compared. RESULTS: We identified 7 key TOT components that explain variations in PTOT. Average anesthesia PTOT is 15 minutes, whereas average GI PTOT is 34 minutes (25.9% versus 57.2% of case length, p=0.0007). In Phase II, mean sTOT improved from 18.51 to 14.25 minutes (p<0.0001) and proportion of sTOT within 15 minutes improved from 41.79% to 58.90% (p<0.0001). This intervention saved 45 mins/room per day, allowing for a revenue potential of more than $300,000 per year per procedure room. CONCLUSIONS: This study defines variations in TOT and demonstrates that finding imbalances and sharing the workload significantly cuts costs and improves the overall efficiency of the different subgroups in the turnover process.
