The Hospital’s GI and pulmonary endoscopy procedure unit is likewise bustling, serving more than 8,900 pediatric and adult patients annually, with a caseload in excess of 40 patients per day. At the unit’s helm is Abel Biri, the director of the Florida Hospital’s Digestive Health Center, and Charla Albury, RN, the unit’s nurse manager.

Biri was given oversight of the unit in early 2007 after it experienced steady declines in 2005 and 2006 in both procedural volume and revenue. While understanding the stiff competition from free-standing facilities, Biri’s first thought was that the unit was potentially missing revenue opportunities. That’s when he called in the Olympus EndoSite¹ team to conduct Reimbursement² and Operations and Efficiency³ analyses.

"I was concerned about our efficiency," explained Biri. "It seemed it cost too much and took too long to get patients through the process, and there were no operating guidelines for the unit. I needed experts to take a closer look. I also wanted to see if our reimbursement was commensurate with the type of patient case mix in our unit," stated Biri.

Seasoned Olympus endoscopy consultants Joanne Harbaugh, BS, RN, CGRN, and Nancy Schlossberg, BA, BSN, RN, CGRN, were assigned to the project, and they quickly established an easy working relationship with Biri. The EndoSite consultants examined the reimbursement charge capture process as well as uncovered gaps in the unit’s patient and staff workflow processes. To get to the bottom of the unit’s operational issues, Biri extended his work with EndoSite in early 2007 to have them help implement strategies and best practices to further enhance patient care and improve revenues.

"Nancy and Jo made significant recommendations with compelling rationale. Their expertise and guidance made it easy to make some difficult decisions," commented Biri.

Gathering reliable data, the consultants uncovered key areas that were not consistent with national benchmarks⁴ for peer facilities. "Staff costs per case were elevated, overtime was excessive, inpatient cancellations were high, patient throughput was lengthy, flow was not optimal, reprocessing facilities were inadequate and endoscopy equipment was aging," said Harbaugh. "We were dealing with leadership, staff and physicians that were very faithful to the Hospital’s mission to care for patients. Once we uncovered the culprits contributing to diminished procedural volume and declining revenue, our goal focused on determining appropriate process improvements to reverse those trends."

But all the data in the world doesn’t help improve the process unless you can actually act on that knowledge. "Assembling the right team is essential," stated Schlossberg. One of the most important factors in the success of Florida Hospital Orlando’s improvements was the leadership and consensus-building ability of Biri. "He immediately involved all of the stakeholders in the process to get their buy-in and expertise. Then he made sure it happened," said Schlossberg. Biri brought in the Hospital’s administrators, physicians, Infection Control and the OPI (Operational Performance Improvement) team. Albury, the unit’s new nurse manager, was the other key person in the implementation process. "If Abel was the brick, Charla was without doubt the mortar. She was a master change agent, taking accountability for making things happen, all while maintaining a team approach to delivery of patient care and keeping morale up," added Harbaugh.

The Olympus team, in turn, included the two consultants, EndoSite analysts, an endoscopy support specialist and the Olympus sales representative. "All the participants were very valuable. The complement of the hospital and Olympus groups working together ensured seamless implementation of recommended processes and protocols," said Harbaugh.

"EndoSite presented an outside objective eye, but OPI really provided the force that translated team ideas and suggestions into realistic, measurable goals for operational processes. OPI and the Florida Hospital Orlando team continue to re-evaluate the unit’s progress and raise the bar ever higher," explained Schlossberg.

Working as a team, the group set about implementing the solutions recommended by the EndoSite consultants. "Most of the issues were actually interrelated," explained Schlossberg. "Overtime was high because the unit did not keep tight control over physicians’ procedure scheduling. The inadequate endoscope reprocessing areas contributed to equipment damage, downtime and scheduling delays. Nurses performed non-nursing tasks and so on. We took a look at each variable and determined where we could make changes to best effect."

Some of the most important process improvements to increase efficiency and control costs included:

Modifying staff mix: Using two RNs in each procedure room contributed to high staff cost per case. The staffing mix was changed to reflect current Society of Gastroenterology Nurses and Associates, Inc. (SGNA) standards and guidelines as well as Olympus benchmarks. Likewise, the team evaluated tasks associated with each job process to determine who needed to perform each function based on licensure requirements, competencies and available staff. As procedural volume increased, Full Time Equivalent (FTE) staff was also added while maintaining a lower staff cost per case than was obtained prior to the start of the project.

Compressing schedule: To eliminate gaps in the schedule, the team reduced the number of actively scheduled procedure rooms. The unit also established regular hours of operation, significantly decreasing overtime associated with non-emergent after-hours and weekend procedures.

Streamlining workflow: Alterations such as removing clutter from the workspace, relocating equipment and adding patient transporters, among other things, helped streamline the flow of patients, staff and equipment.

Redesigning the reprocessing flow: Increasing the size and changing the layout of the reprocessing area allowed staff adequate room to handle the endoscopes, minimizing the risk of damage and the associated downtime required for repair. Less damage resulted in fewer scheduling delays and reduced overtime required to reprocess scopes at the end of the day. Olympus worked with the reprocessing staff and the hospital’s infection control coordinator to establish consistent reprocessing protocols and ensure the staff responsible for reprocessing had the benefit of the most up-to-date training on equipment.

Accelerating patient throughput: The team prioritized patient processes, standardized discharge criteria and incorporated best practice protocols to improve patient throughput.

Minimizing case cancellations: High acuity inpatients comprise a significant number of the unit’s procedure volume. Arranging for endoscopy-based transport and assigning optimal procedure times for these patients helped decrease cancellation rates and costly delays.

Upgrading equipment: With a high case volume and some reprocessing wear and tear, the unit’s endoscopes were beginning to show their age. The unit acquired all new equipment under an Olympus Cost Per Procedure arrangement that included a full service contract. This helped minimize downtime and controlled repair-related expenses.

"The process improvements implemented through EndoSite addressed my concerns—namely to reverse declining volumes and revenues associated with loss of that volume," said Biri. "In the end, we did more than reverse those trends; we improved the patient experience and increased staff and physician satisfaction. Our work is not yet done, but we’ve made tremendous progress and now we have a roadmap towards becoming a preeminent unit."

Olympus EndoSite Consulting Services offers a comprehensive collection of professional services to help healthcare facilities improve efficiency, maximize revenue and optimize service delivery
while enhancing patient care, safety and satisfaction. For more information about EndoSite and how our services can help your facility, please visit olympusamerica.com/endosite or contact your Olympus sales representative.