10 Strategies to Improve Endoscopy Center Operations

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Ruth Keogh, RN, nurse manager at Digestive Health Associates Endoscopy Suites in Stoneham, Mass., cites 10 ways to improve quality and efficiency in an endoscopy center.

1. Get input from staff. One of the best ways to improve operations, Ms. Keogh says, is to listen to staff. "I can't be everywhere and staff members can provide some great ideas," she says. She adds that what may sound like a complaint is often an opportunity to improve. At DHA Endoscopy, "people are not afraid to speak up when things need to be improved," she says. Input at the center can be informal, since it has just 19 employees and Ms. Keogh is often working side-by-side with a staff member. There are also monthly staff meetings. "We have a great dialog here," she says. "The per diem employees contribute as much as anyone else."


2. Cross-train to give staff big picture. Cross-training is beneficial even when staff never perform the extra duties they have been cross-trained in. Getting a clear idea of what another person does broadens an employee's understanding of the whole operation. "It makes for better team-building and a more smoothly running facility," Ms. Keogh says. When recovery room and admitting nurses are trained do each other's job, they all know how to put IVs in and they understand the full surgery process from end to end.

3. Improve adherence to bowel prep. Improving patients' adherence to bowel prep can reduce cancellations. One way to improve adherence is to rewrite the paperwork the patient receives prior to the procedure so that it is clear and unambiguous. Another way is to set up a 24-hour hotline where patients can ask physicians about preparation procedures. Physicians' hotline duties can easily be piggy-backed onto overnight call duties at the hospital, Ms. Keogh says.


4. Insert breaks to get schedule back on track. "Running late affects patient satisfaction and staff morale," Ms. Keogh says. The surgical schedule can be disrupted for a variety of reasons that can be out of anyone's control. One way to address this problem is for the physician to insert two half-hour breaks each day, which cushion the effect of a late schedule. If cases are running behind, the physician can shorten his upcoming break and start the next case at the scheduled time.


When scheduling a case, it is necessary to be realistic about each physician's pace, Ms. Keogh says. "Some GI physicians can do 10 colonoscopies in eight hours while others cannot," she says. Physicians with a slower case should be scheduled for more time so that no one has to run late. Another way to keep the schedule on time is to track physicians who have been running over their allotted time and send them reports monthly.

5. Replace equipment regularly. "Physicians just feel happier using new equipment," Ms. Keogh says. In addition, updated versions of the equipment can improve quality and efficiency. For example, DHA Endoscopy recently acquired narrow-band imaging, which enhances the fine structure of the mucosal surface, helping to improve detection in a colonoscopy. The center also recently bought high-definition monitor screens, which allow physicians to see a lot more.

6. Physicians can keep staff educated. One way to keep clinical staff members up-to-date in the newest techniques is to ask physicians to pass along what they learned in a CME course. The knowledge transfer does not have to be in a meeting. "It’s informal," Ms. Keogh says. "They don't even have to sit down." It can be done while the physician is working with staff members. Nurses can also receive clinical education geared to them in outside sessions such as at meetings of the Society of Gastroenterology Nurses and Associates.


7. Embrace change. As physicians and staff learn better techniques, clinging to old ways of doing things can get in the way. "The challenge is being able to step outside of yourself, take a clear look and say, 'Maybe what we have been doing forever doesn't work,' " Ms. Keogh says. For example, even though it has been shown that IV bags don't need to be hung for moderate sedation in many cases, "some nurses were initially against this, because it was not what they were taught," she says. Eventually, however, they understood that the standards have changed.

8. Focus on local best practices. While following national benchmarks and best practices is useful, it's also important to focus on what is done locally, Ms. Keogh says. For example, "physicians in one area tend to have similar preferences," she says. Ms. Keogh maintains regular contact with colleagues at other centers to discuss benchmarks and best practices, usually through e-mails and phone calls. She does not limit her discussions to endoscopy centers because all centers share many concerns, such as use of IV bags, she says. Some key metrics, however, are specialty-specific, such as cecal withdrawal times, the time spent examining the colon during withdrawal of the colonoscope. Polyps are more likely to be found if the cecal withdrawal time is longer than six minutes, she says.

9. Identify high-acuity patients before procedure. Some cases have to be cancelled at the last minute because when the patient arrives, it turns out he or she has a higher acuity level and should have the procedure done at the center. For example, a patient with home oxygen has an ASA-3 level, ruling out care at DHA Endoscopy. To avoid last-minute cancellations for these reasons, patients going to the center register and fill out paperwork for the procedure at the physician's office.

10. Track and fix patient satisfaction. DHA Endoscopy mails patients a satisfaction survey and logs a respectable 50 percent return rate, with scores on most of the questions in the 97-99 percent range. Questions cover cleanliness, the level of pain and how successful staff was in teaching the patient. Staff members read results carefully, sometimes noting a slip in the score for a certain category. "When we start to see a slip, we talk about how we can fix it," Ms. Keogh says. "Things get fixed very easily because people here care about the results."


Find out more about Digestive Health Associates Endoscopy Suites.


Related Articles on Endoscopy Centers:

6 Ways a One-Physician Endoscopy Center Maintains Success and Profitability

New Endoscopy Surgery Center Planned for Honolulu

6 Best Specialties for Surgery Centers


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