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DOI: 10.1055/a-2290-0263
Plan-do-study-act (PDSA) interventions to improve real-world endoscopy unit productivity
Abstract
Background and study aims The Plan-Do-Study Act (PDSA) ramp is a framework that uses initial small changes to build consensus and momentum for subsequent, iterative process improvement. Our aim was to study its impact on endoscopy unit efficiency and throughput.
Methods Following a granular time-and-motion analysis to evaluate baseline performance (phase 1) we instituted successive interventions and measured their impact on core efficiency metrics including procedure volume and turnover time (phases 2–3).
Results We identified that inefficiency in turnover of anesthesia-supported endoscopy was the most crucial issue. Implementation of a pre-procedure anesthesia visit in phase 2 reduced turnover time by 15.5 minutes (95% confidence interval 3.9–27.1 minutes). Subsequent changes (phase 3) including front-loaded procedure scheduling and parallel in-room preparation resulted in an 18% increase in procedure volume.
Conclusions The PDSA ramp model is an effective means of assessing operational processes, developing novel interventions, and building consensus to improve the real-world productivity in a resource-conscious manner.
Keywords
Quality and logistical aspects - Preparation - Quality management - Performance and complicationsPublication History
Received: 30 October 2023
Accepted after revision: 06 March 2024
Accepted Manuscript online:
19 March 2024
Article published online:
03 May 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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References
- 1 Lin MY, Mishra G, Ellison J. et al. Differences in patient outcomes after outpatient GI endoscopy across settings: a statewide matched cohort study. Gastrointest Endosc 2022; 95: 1088-1097 e17 DOI: 10.1016/j.gie.2021.12.025. (PMID: 34979119)
- 2 Peery AF, Crockett SD, Murphy CC. et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2021. Gastroenterology 2022; 162: 621-644 DOI: 10.1053/j.gastro.2021.10.017. (PMID: 34678215)
- 3 Meyer GS, Jacoby I, Krakauer H. et al. Gastroenterology workforce modeling. JAMA 1996; 276: 689-694 (PMID: 8769546)
- 4 Buxbaum JL, Bradley CP, Lee WA. et al. Addressing postpandemic disruption in a safety net EU. Gastrointest Endosc 2022; 96: 135-138 e1 DOI: 10.1016/j.gie.2022.03.003. (PMID: 35568505)
- 5 Lopetegui M, Yen PY, Lai A. et al. Time motion studies in healthcare: what are we talking about?. J Biomed Inform 2014; 49: 292-299
- 6 Friedman DM, Sokal SM, Chang Y. et al. Increasing operating room efficiency through parallel processing. Ann Surg 2006; 243: 10-14
- 7 Day LW, Belson D. Studying and incorporating efficiency into gastrointestinal endoscopy centers. Gastroenterol Res Pract 2015; 2015: 764153 DOI: 10.1155/2015/764153. (PMID: 26101525)
- 8 Weinbroum AA, Ekstein P, Ezri T. Efficiency of the operating room suite. Am J Surg 2003; 185: 244-250 DOI: 10.1016/s0002-9610(02)01362-4. (PMID: 12620564)
- 9 Overdyk FJ, Harvey SC, Fishman RL. et al. Successful strategies for improving operating room efficiency at academic institutions. Anesth Analg 1998; 86: 896-906 DOI: 10.1097/00000539-199804000-00039. (PMID: 9539621)
- 10 Day LW, Belson D, Dessouky M. et al. Optimizing efficiency and operations at a California safety-net endoscopy center: a modeling and simulation approach. Gastrointest Endosc 2014; 80: 762-773 DOI: 10.1016/j.gie.2014.02.1032. (PMID: 24796958)
- 11 Kaushal NK, Chang K, Lee JG. et al. Using efficiency analysis and targeted intervention to improve operational performance and achieve cost savings in the endoscopy center. Gastrointest Endosc 2014; 79: 637-645 DOI: 10.1016/j.gie.2013.10.037. (PMID: 24321391)
- 12 Yong E, Zenkova O, Saibil F. et al. Efficiency of an endoscopy suite in a teaching hospital: delays, prolonged procedures, and hospital waiting times. Gastrointest Endosc 2006; 64: 760-764 DOI: 10.1016/j.gie.2006.02.047. (PMID: 17055870)
- 13 Zamir S, Rex DK. An initial investigation of efficiency in endoscopy delivery. Am J Gastroenterol 2002; 97: 1968-1972 DOI: 10.1111/j.1572-0241.2002.05909.x. (PMID: 12190162)
- 14 Berg B, Denton B, Nelson H. et al. A discrete event simulation model to evaluate operational performance of a colonoscopy suite. Med Decis Making 2010; 30: 380-387 DOI: 10.1177/0272989X09345890. (PMID: 19773583)
- 15 Yang D, Summerlee R, Suarez AL. et al. Evaluation of interventional EU efficiency metrics at a tertiary academic medical center. Endosc Int Open 2016; 4: E143-E148 DOI: 10.1055/s-0041-108082. (PMID: 26878040)
- 16 Almeida R, Paterson WG, Craig N. et al. A patient flow analysis: identification of process inefficiencies and workflow metrics at an ambulatory EU. Can J Gastroenterol Hepatol 2016; 2016: 2574076 DOI: 10.1155/2016/2574076. (PMID: 27446830)
- 17 Bjorkman DJ. Efficiency in endoscopy: imperatives and pitfalls. Gastrointest Endosc 2008; 68: 1054-1055 DOI: 10.1016/j.gie.2008.05.002. (PMID: 19028214)
- 18 Gellad ZF, Thompson CP, Taheri J. EU efficiency: quality redefined. Clin Gastroenterol Hepatol 2013; 11: 1046-1049 e1 DOI: 10.1016/j.cgh.2013.06.005. (PMID: 23978500)
- 19 Rex DK, Lahue BJ, Dronzek RW. Impact of two procedure rooms per physician on productivity and computer simulation examines the impact of process change in the hospital gastroenterology department. Gastrointest Endosc 2005; 61: AB154
- 20 Harewood GC, Chrysostomou K, Himy N. et al. A "time-and-motion" study of endoscopic practice: strategies to enhance efficiency. Gastrointest Endosc 2008; 68: 1043-1050 DOI: 10.1016/j.gie.2008.03.1116. (PMID: 19028212)