Secrets of Colonoscopy Efficiency

Small process tweaks and seconds-saving improvements add up when you’re performing thousands of procedures each year.

Ever since the recommended age for colonoscopy screening dropped to 45, a growing number of high-volume GI facilities dealing with increased volume are considering investments in the latest technology, including artificial intelligence (AI) and state-of-the-art endoscopes, as well as streamlining their reprocessing and storage capabilities to meet the surging demand. The ultimate driver behind these investments is to make colonoscopy lines more efficient and effective and better serve more patients than previously possible.

Low-hanging fruit

If your GI center or ASC doesn’t have the resources to make these types of investments, that’s OK. Making your practice more efficient doesn’t need to be centered around major changes or upgrades. What we’ve found is that a constant effort to identify small changes we can make as we go — an improved piece of equipment, an innovative way to integrate technology, or even slight changes in our workflow — can consistently improve efficiency over time.

Our center performs about 20,000 procedures annually, and 70%-80% of those are colonoscopies. Even small improvements in how quickly we can get a patient from intake to discharge can make a big difference in how smoothly our center runs. For example, a few years back we switched from a wall suction with a solidifier that required cleaning after each use to a version that didn’t. Not only did we save money on our biowaste costs, but we also reduced room turnover time by three to four minutes. Always look for those small changes you can make in all aspects of the process.

Communication creates opportunities

We don’t have a formal approach for investigating ways to streamline our process, but our staff communicates well with each other and with leadership. They’re always willing to share their insights on different aspects of the service line.

When someone has an idea that could save time on the process, they share it and we try it out. In most cases, these ideas focus on a particular aspect of the line and ultimately might shave 10 to 15 seconds off the patient experience. The thing is, those little process improvements add up over time.

Patient prep sets the tone

One of the most important elements in streamlining our colonoscopy process is patient prep. If a patient skips part of the prep process, such as not taking the drink, delays or cancelations can result. So we make the process as clear and easy as possible for them. We provide them with links to our website that contain directions and information about why the prep is so important. We also provide paper copies, and text or email remainders the day before their procedure.

The trend of patients taking GLP-1 agonists is currently impacting our prep process. We tell them to stop taking the medication a week before their procedure, but they don’t always comply. Our challenge is to find a way to mitigate this issue by making the information clearer to patients well before the procedure.

Scheduling is another area in which we work to create a more efficient patient flow. We book two patients per hour for each physician. Then, if a patient needs to cancel for some reason, we still have a patient slotted for each physician.

We also developed a preregistration link that patients can click to input their information, which then feeds directly into our EHR. About 70% of our patients now use this option, which is a rather favorable rate considering that some people just don’t like using technology. The patients who don’t preregister check in at the front desk. We strive to keep that interaction as simple as possible.

After check-in, we perform preoperative assessments in a separate room from where the procedure will take place. For us, this is a more efficient way to get patients ready without using a pre-op bay. For sedation, we generally use propofol, which metabolizes a little more quickly and tends to result in shorter recovery times than midazolam and fentanyl.

Room turnover

Our staff has done an amazing job in driving our room turnover times down to about five minutes — that’s from the time one patient is pulled and the next is pulled in.

The first, crucial step we took to reduce turnover time was to set all of our procedure rooms up exactly the same way. No matter what room our providers are in, everyone knows where everything is at all times. It just makes it faster to do everything. We’re always rethinking some of the devices we use and how we use them. Among other things, we’ve switched to tubings that are good for 24 hours instead of one-time use, and we have a scope reprocessor on each side of the building.

Speaking of reprocessors, we switched to machines that don’t require precleaning for most scopes. Eliminating that precleaning step probably saves us five minutes each time. Our perioperative staff transports used scopes to the reprocessing room to save our reprocessing techs time. It’s those little time-saving touches here and there that collectively drive down overall procedure times.

Tapping in to technology

Integrating technology has also been a useful way for us to improve our efficiency throughout the center. While we’ve looked into using AI, our doctors found it didn’t provide enough benefits to justify the cost — for now. It’s something we’re keeping an eye on, however.

Fortunately, simpler technologies have provided great results. Our EHR is basically a point-and-click system without a lot of free text fields that require typing answers. It works on mobile devices, which enabled us to provide staff with iPads to handle the consent process and similar tasks. These devices enable staff to stay with the patient rather than leaving to go back and forth from the patient to a desk. Although there was a slight learning curve, staff found it to be quite intuitive. In fact, we saw time-saving benefits almost right after implementation.

Improving efficiency is about inhabiting a mindset of continuous, incremental progress. Avoid getting stuck in doing things the same way, be open to making small adjustments and your center will see significant results over time, just like ours did. Being adaptable and communicating our ideas led to a smoother, more effective operation that benefits our staff, our physicians and our patients. OSM