1. Space and design issues
New/existing centers frequently design the center with an adequate number of procedures rooms to accommodate the physicians’ daily volume but fail to provide adequate preop and recovery room space. Due to the short procedure time and fast turnover, the preop area needs to keep at least two patients ready per procedure room. This works well if all things go as planned (Does this ever happen?). Patients have taken a prep and often need to use the restroom (proximity to the GI areas should be considered), patients may have their procedure cancelled after arriving in preop, the patient may have a difficult IV, etc. All these things may delay getting the patient ready and take up a bed in the preop area. If you are unable to get another patient ready, the physician will have downtime in his or her day.
Another consideration for number of pre and post beds needed is the type of sedation to be used. Patients receiving propofol will need a shorter recovery time than those receiving traditional narcotics and sedatives. If propofol is not used, you may need additional post-operative beds. I have been in poorly designed facilities where there is a plan to expand GI services, but with only one pre- and one post-operative bay, the throughput of the patients is severely hampered.
2. Staff issues
Additional staff is required to keep up the fast pace of GI. In a multi-specialty center, there are other patients to get ready and the requirements for these patients may be very different from the GI patient. One nurse is needed to preop all patients for each procedure room. Also, as discussed above, the type of sedation may affect the staffing. Consider the sedation type used, any regulatory requirements and patient safety in your planning. You will also want to consider your state requirements related to who is allowed to administer the planned sedation/anesthesia, as well as any state mandated staffing requirements.
3. Equipment and instrumentation issues
Equipment and instrumentation is also required to keep up the fast pace of the GI physician. When estimating the number of scopes, etc., the method and time required for proper cleaning of the scopes should be taken into consideration. If you are running one room with one physician doing procedures back to back, you need at least two scopes and three would ensure that you always have a scope.
4. Education of the endoscopist
Failure to educate the endoscopist as to actual cost of supplies can be a very costly mistake. Clamps vary greatly in price (range of $20-$200). If your physicians are unwilling to standardize and/or use the preferred vendor of your ASC, any potential profit may rapidly evaporate.
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