Hospital propels its endoscopy center to the next level with efficiencies

by Debbie Wells, R.N., Peggy Gould, R.N., BSN, and Debby Kelley

When the administrators at Torrance Memorial Medical Center saw more than 17 percent of their endoscopy business deteriorate in the summer of 2005, they knew they had to take action.

"We were quickly losing patient volume to stand-alone endoscopy centers because we could no longer meet physicians’ expectations," explained Peggy Gould, R.N., BSN, the director of Torrance’s endoscopy center, an accredited, full-service, 377-bed, nonprofit community medical center located in Los Angeles’ South Bay. "We saw our caseload decline from 790 cases per month to 650. Physicians were unhappy with the inefficiencies rapid growth brings, patients weren’t satisfied with the service delays and our staff morale was diminishing."

Things needed to change, but understanding what changes would yield the most desirable outcomes was complex. How could Torrance’s endoscopy center maximize efficiency within a restricted physical space, fulfill the ongoing need for staffing, meet physicians’ expectations for effective room turnover, and optimize patient flow for efficient throughput and positive impact on its bottom line?

"It was clear that with our limitations on space, expansion was the obvious answer to address our key issues," said Debby Kelley, Torrance’s vice president of ancillary and support services. "Expansion, however, requires a fairly significant amount of development time while our patient flow needs were more immediate."

Moving proactively to satisfy their most pressing requirements, Kelley and her team solicited the support of Olympus EndoSite Consulting Services.

Predicting future outcomes

Torrance’s situation proved to be a perfect application for Olympus’ proprietary modeling software, designed specifically for GI facilities. Using the EndoEfficiencies Simulation and Predictive Outcomes model, Olympus and the Torrance team were able to systematically and accurately replicate patient flow through the hospital’s endoscopy center, based on the center’s existing protocols, resource requirements and other variables specific to Torrance.

Using the predictive analysis capabilities built into the EndoEfficiencies model, Olympus simulated various changes in the endoscopy center operation. "These analyses helped the medical center team understand and evaluate the predicted fiscal impact of various scenarios prior to committing to costly and potentially disruptive changes," noted Vicki Thavorides, R.N., MSHA, one of the Olympus EndoSite advisors working with Torrance Memorial.

Though expansion planning is underway, the EndoEfficiencies analysis helped demonstrate to the Torrance team other innovative ways to meet their current objectives in the near term. "Our immediate priority was to stabilize our operation and recoup the business that we had lost," said Kelley.

Identifying opportunities
for change

The EndoEfficiencies simulation revealed that Torrance had the capacity to reduce length of stay for each patient by 53 minutes, improve the track record for ending procedures "on time" from an estimated 38 percent to 96 percent, and eliminate the need for patient overflow locations by implementing a few key changes, including:

• Purchasing five additional stretchers and modifying utilization of the prep/recovery space

• Creating a stringent pre-registration process to reduce patient and staff time spent in prep

• Adding technicians in room turnover preparations

• Developing a modified physician block schedule

Implementing operational improvements

In March 2006, Torrance’s staff began implementing the changes suggested by the EndoEfficiencies simulation. "We haven’t incorporated everything yet, such as physician block scheduling, but in these first three months, we’re already seeing dramatic results," commented Debbie Wells, R.N., the supervisor of Torrance’s GI lab.

With streamlined operations, the endoscopy center is not as reliant on other, less conveniently located recovery areas. For example, overflow sent to the cath lab for recovery has decreased by 60 percent, saving the endoscopy staff time and putting fewer demands on the cardiac staff.

Furthermore, procedures are now starting on time more often. In the past, 15 percent of late starts could be attributed to operational issues with the GI staff.

"This created a domino effect," said Gould. "Physicians weren’t motivated to arrive on time because they assumed the GI staff wouldn’t be prepared."

With GI staff-related late starts now down to 5 percent, Torrance has seen physician-related late starts cut almost in half, dropping from 44 percent down to 23. "Our last big hurdle," said Gould, "is getting the patients themselves to arrive on time."

Starting on time also means greater success in ending procedures on time. "Running overtime was a major complaint from physicians," said Gould. "Now with 32 out of every 40 cases ending on or before the scheduled time, we’re not hearing those same complaints."

With Torrance better able to adhere to a reliable schedule, it frees up the endoscopy center’s space and core resources for other activities in the afternoon. "When Torrance was approached by a pain management physician who was pursuing the facility for his afternoon practice, we knew we were able to handle his cases and any additional increased volume," said Gould. "Since his practice began at Torrance, he has been able to double his patient load."

By adding technicians to assist with room preparation, furthering the professional development of the R.N.s and establishing lead nurses, Torrance has seen job satisfaction escalate. "The attitude of the staff has completely changed. Morale has dramatically improved. Staff enjoy their jobs," noted Gould. "And we’ve seen the physicians’ concerns diminish. The doctors comment positively about the techs and the staff all the time. They’re appreciative of them. It’s a huge change."

Recognizing positive results

The end result: Procedural volume is back up and the Torrance team is now looking for further procedure growth due to the endoscopy center’s newly created capacity — something they couldn’t even consider in the past. "It was very gratifying to work with the Olympus EndoSite team. They understood our business and could offer the GI expertise we needed, gaining the trust of our staff and showing us constructive opportunities for improvement. The EndoSite team’s recommendations allowed us to make quick, effective changes, and more importantly, they were there to train us and support us through the process," said Wells.

Optimizing facility resources

EndoEfficiencies analyses help medical facilities like Torrance Memorial pursue solutions predicted to yield the highest return relative to the required investment. Based on the variables unique to each facility, EndoEfficiencies modeling develops recommendations for optimal resource utilization (including staff, equipment and space) and looks for opportunities for improved throughput, increased procedure capacity and decreased costs. HPN