Optimizing Efficiency and Operations at a Large California Safety-Net Endoscopy Center: A Modeling and Simulation Approach

Abstract

Improvements in endoscopy center efficiency, especially in safety net hospitals, are needed, but scant data are available. A time and motion study was performed and a discrete simulation model constructed to assess changes in scheduling, staffing models, and the pre- and post-procedure process and its impact on several performance measures in a safety net hospital endoscopy center. Decreasing the endoscopy appointment time from 60 to 45 min led to a 21% rise in the number of procedures performed per week, but unfortunately increased patient wait time by 42% while further reductions in appointment times led to even more significant queuing. However, increasing the number of pre-procedure nurses from 1.5 to 2 resulted in a 22% increase in the number of procedures performed per week and increased provider, nurse and procedure room utilization with minimal impact on patient wait time. Further increases in nurse staffing resulted in no significant changes to measured outcomes. Increasing the number of endoscopists by one each half day resulted in procedure volume rising, but there was a concomitant rise in patient wait time and nurse utilization exceeding capacity. A significant improvement in performance metrics was created by moving patient appointments from afternoon to morning appointments. In this simulation at 45 and 40 min appointments procedure volume rose by 23 and 34% respectively, all utilization metrics increased and patient time spent in the endoscopy center declined by 17 and 13%. Thus the combination of minor, cost-effective changes such as reducing appointment times, minimizing and standardizing recovery time, and making small increases in pre-procedure ancillary staff maximized endoscopy center efficiency across a number of performance metrics. The simulation made it possible to identify which changes were desirable and to what extent.