QI Spotlight: Improving patient access to colonoscopy/endoscopy by increasing room utilization

Successful applicants to the ��Endoscopy Unit Recognition Program submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The QI project in the spotlight this month looked at improving patient access to colonoscopy/endoscopy by increasing room utilization.

DEFINE

We have noticed that there are often rooms being underutilized for entire or partial days and that the patient backlog of procedures has increased. We hypothesized that we could improve room utilization by engaging physicians more in the process of block time assignments.

MEASURE

We assessed the number of patients in our system waiting to be scheduled for screening colonoscopies.

We looked at endoscopy room utilization by calculating the percentage of hours a room was in use (defined as a patient scheduled). A full day in one room was considered to be 8 hours (7:30am-3:30pm).

ANALYZE

We first looked at room utilization over a 12-month period to establish a baseline: 75% Screening colonoscopy backlog prior to implementing below procedures: 508

IMPROVE

We implemented the following procedures:

Analyze room utilization on a monthly basis for the endoscopy unit overall and per physician.
Physicians must provide notice of giving up block time (e.g., for vacation, conference) at least 3 months in advance but preferably longer.
Scheduler created a spreadsheet of room blocks with availability based on physician absences and routinely sent out emails to physicians who would then volunteer to take available blocks.

RESULTS

Repeat assessment of room utilization after 12 months increased from 75% to 85%. Screening colonoscopy backlog decreased from 500 to 53.

Physician wRVU increased on average 156 wRVU per physician per month over this 12-month period.

SUMMARY

We found that a few small, no-cost changes targeted to improved communication between schedulers and physicians can increase room utilization. As a result, the following benefits were attained:

increased patient access for more procedures and more timely procedures,
decreased backlog of patients waiting for screening colonoscopies,
increased hospital revenue, and
increased physician wRVU.

Results of improvements have been communicated to the GI department by email, in regular meetings, and also communicated with hospital administration. Limitations of the project are that there may be other reasons for some of the positive findings (e.g., decrease screening colon backlog, increased physician wRVU). We believe nonetheless that the improvements we made are sustainable and likely can be improved further. We consider 85% to still be too low. While there are fewer days and hours that rooms are not being used, this is not zero. We are looking for ways to improve room utilization further- for example having a "buddy'' system for when one physician gives up block time (e.g,. pairing up two physicians whose endo and office times are different/opposite), and we will be looking into utilizing artificial intelligence to manage multiple physician schedules (both office and endoscopy} more efficiently. Some barriers to further improvement may be office schedulers' push-back when a physician reschedules office patients in order to add an extra block of endoscopy time, as well as cost of any new software management programs. We also plan on extending the above processes to our other sites/facilities.

We hope sharing this project summary will be useful to you and your practice. Learn more about gaining honoree status in the ��Endoscopy Unit Recognition Program. EURP honoree units may use the ��Quality Star logo in promotion of their units, receive premium educational content via an exclusive e-newsletter The Huddle, and enjoy a range of additional benefits. Questions should be directed to eurp@asge.org