Capitalize on the New Lower Age for Colonoscopy Screenings

Employ these tried-and-true strategies to handle increased demand.

Between an aging population and the reduced recommended screening age of 45 for colonoscopies, demand for colorectal and related screenings is increasing. With more patients seeking procedures amid a shortage of gastroenterologists, GI centers must find ways to accommodate more patients without making already-long wait times worse.

Even an optimally run GI center has finite capacity, however. Fortunately, there are several steps centers can take — involving various areas of the practice — to increase capacity and make things easier for providers and patients.

Selective self-service

At NYU Langone Health, one helpful change has been allowing some patients to self-schedule their screenings, says Seth A. Gross, MD, FACG, FASGE, AGAF, professor of medicine and clinical chief with NYU Langone’s Division of Gastroenterology and Hepatology. “Average-risk younger patients have generally already seen an internist who recommended the screening,” explains Dr. Gross. “We have a questionnaire looking at several factors to ensure they are lower-risk and, if they qualify, they get a notification that it’s time to set up an appointment.”

Dr. Gross says NYU Langone’s scheduling window is easy to use — like the apps and websites people use to make restaurant reservations. Once the appointment is made, patients can have bowel preparation instructions and other material emailed to them. Importantly, there is always an option to speak with a person at the office if they have additional questions.

This limited self-scheduling cohort has reduced a significant administrative burden on staff, while the patients love the convenience — especially not needing to make a phone call. As a result, patients at higher risk or who have symptoms can speak with someone in the office sooner to make an appointment.

Waitlists and extended hours

An idle endoscope does nobody any good. As such, Dr. Gross recommends waitlists to fill slots that would be left open due to cancelations, or adding extended or weekend hours to keep up with demand. The combination of self-scheduling and waitlists has made a positive impact for NYU Langone and its patients. “The priority is to see people with symptoms in a timely fashion and we’ve been able to do that,” he says. “If a particular patient is particularly motivated, we can usually accommodate them to be seen a little faster.”

Scheduler changes

A simple but perhaps pricey way to meet demand and fill available slots of colonoscopies months into the future is to simply hire more people as schedulers. That’s what Lakeland (Fla.) Surgical & Diagnostic Center has done. Nikki Williams, RN, CNOR, executive director of Lakeland’s Florida campus, says her center’s scheduling system is powered by four full-time schedulers who work at full capacity due to the volume of patients.

With her center recently acquired by a larger clinic, Ms. Williams expects improvements that will further streamline scheduling for staff and patients. “Our resources have been limited,” she says. “But I feel confident that there will be a lot of improvements.”

Self-scheduling, waitlists and dedicated scheduling staff are low-tech solutions that can help accommodate increased demand. However, cutting-edge technology options are also available that can help improve efficiency and quality.

Shortage-focused cross-training

Ms. Williams says having enough clinical staff on hand is vital to meet demand and maintain daily efficiency. “We have five GI procedure rooms and ensure we maintain enough staff every day to cover and run those five rooms,” she says. “We cross-train certain employees so they can step into roles if we have a shortage. For example, GI RNs and CSTs could work as GI techs or pre-op/PACU staff if needed.”

She notes that adequate staffing mitigates burnout that can lead to higher turnover times and exacerbated delays in seeing patients. Effective communication with staff is also crucial. “Keep staff up to date with possible changes in volume,” she says. “Sometimes they have an expectation and if changes are not communicated, they might be dissatisfied.”

TALKING POINTS

Should the Screening Age for Colonoscopies Be Lowered to 40?

In response to an increasing incidence of cancer — a 2% percent annual increase in diagnoses from 2015 to 2019 — and higher rates of mortality in U.S. women ages 40 to 49, the U.S. Preventive Services Task Force lowered the recommended breast cancer screening age from 50 to 40 in April. Colorectal cancer among the same age group has seen an even higher spike — up 15% among the 40-49 population between 2000 and 2016.

This begs the question: Should the recommended screening age for colon cancer occur even earlier? The Harvard Gazette asked a diverse group of experts on colorectal cancer whether screenings should start at age 40, as opposed to the current and recently lowered age of 45.

It’s likely the notion of an even younger recommended screening age may be difficult to fathom for facilities that have only begun to wrap their heads (and processes) around the recently lowered recommended screening age of 45. The experts in The Harvard Gazette piece seem to agree the spike in cancer rates of younger individuals is a complex issue and simply lowering the recommended screening age isn’t likely as clear-cut a solution as it may seem.

Read the full article about the implications of lowering the colon cancer screening age here.

—Jared Bilski

Turnover time awareness

Another way to squeeze in a few extra patients each day or week is to track how long providers actually take to perform procedures. “If someone is very efficient, we could adjust the time blocks to get an extra one or two patients in each day,” says Dr. Gross. “But that also depends on the staff’s ability to turn over rooms efficiently and safely.”

Dr. Gross’ center uses dashboards to track times for the unit as a whole, as well as monitor more granular metrics such as pre-procedure and post-procedure times. “If you can tighten the time from ‘wheels in to wheels out and next wheels in,’ it is a big benefit,” he says. “We’re always looking at ways to tighten procedures, when they come in and when they can be discharged.” Dr. Gross adds that NYU Langone knows how long it takes each patient to go through each step from registration to discharge.

Dealing with a younger patient cohort

With younger people being advised to get colonoscopies, centers should consider some tweaks to their current procedures with them in mind. Younger patients may have slightly different expectations, and some may not even know about the recently reduced age recommendation for screening. Dr. Gross believes that offering open-access colonoscopy scheduling in the patient portal can save months of wait time since the patient doesn’t need to see a GI provider before scheduling. Again, this is appropriate only for certain low-risk, non-symptomatic patients. “Depending on the clinic, they could even offer this for some other procedures that don’t warrant an initial office visit,” he adds.

Ms. Williams says her center has seen an increase in younger patients, but they’ve been more likely to visit for an esophagogastroduodenoscopy (EGD) than a colonoscopy. Her center views those EGDs as an opportunity to share information with these patients on the lowered age recommendation for colonoscopies.

Although neither Dr. Gross’ nor Ms. Williams’ practices have embarked on significant marketing efforts about the new screening recommendations, they continue to experience high patient demand for colonoscopies. Ms. Williams says her clinic has about 3,000 patients currently waiting for procedures, which equates to a roughly four-month wait.

Through a mix of innovative and practical solutions, GI centers can adapt to the increased demand for colorectal screenings without overburdening staff or creating even longer wait times for patients. Some changes, such as allowing patients to self-schedule, can actually improve the patient experience. OSM