Reading about benchmarks is one thing. Reaching them is quite another. Here's advice on how to reach 5 key benchmarks from the Colonoscopy 2008 Report: Performance Measurement and Benchmarking in Ambulatory Organizations, conducted by the Accreditation Association for Ambulatory Heath Care's Institute for Quality Improvement.

1. Pre-procedure time. Time from when the patient arrives to the time the scope is inserted.
Benchmark: 60 minutes.

Make your pre-op calls 3 or 4 days before the procedure instead of waiting until the day before. Ask that RNs and LVNs take a few minutes at the end of their workdays to contact patients. Our electronic medical records contain a pre-call tab that automatically populates answers into the pre-procedure note. The pre-call tab displays a list of questions we need to ask patients before they arrive, like their demographic information, the type of prep they're using and the medications they're taking. (Patients sometimes forget to bring a list of meds on the day of the procedure; this way they can name the meds off bottle labels). This lets you review and verify information much quicker on the day of the procedure than had you used paper records.

Jana Beasley, RN, CGRN
Assistant Administrator
Wichita Falls Endoscopy Center
Wichita Falls, Texas

2. Procedure time. Time from the beginning of the procedure (scope in) to the time the procedure has ended (scope out).
Benchmark: 17 minutes.

Use 1 circulator and 1 scrub person for each case. The circulator monitors the patient and completes path sheets and charts, while the scrub maintains the scope and helps with additional biopsy forceps, gold probes, clips, snares or other items used.

This staffing model promotes efficiency during the procedure and lets us turn over rooms in about 7 minutes. Here's how. The scrub rinses the scope as soon as it's removed and transports it to our reprocessing area. Meanwhile, the circulator unhooks the patient from the monitoring equipment. Upon returning, the scrub helps the circulator transport the patient to the post-procedure care area. Circulators used to move patients alone, but we've found that 2 people can maneuver stretchers around winding halls and tight corners more efficiently. Plus, the scrub can now bring the stretcher back to the procedure room, freeing the circulator to help prep the next patient.

Back in the procedure room, the scrub calls up the next patient's record on the room's computer and opens a linen pack containing towels and an absorbent pad (that she places on the stretcher), gauze, gloves for the physician and a bite block (for upper GI cases). By the time she's done setting up the room, the patient is arriving for the next case.

Grace Brehm, RN
Manager
Toledo Clinic Outpatient Surgery Center
Toledo, Ohio
[email protected]

3. Discharge time. Time from the end of the procedure (scope out) to the time the patient meets criteria for discharge.
Benchmark: 41 minutes.

Assign 2 nurses to each physician for pre- and post-procedure care. The nurses work in bays, each one assigned to a specific physician for the day. After pre-procedure preparation, nurses transport patients to the procedure room, then back to the same bay for post-procedure care. The nurses there already know patients' histories when they return and any special assistance or targeted care that they might need, which cuts the patient ID questions in half and lets us complete the post-procedure report very quickly.

We used to write patients' bay numbers on a sticky note attached to their charts, but the note would often fall off or get covered by other documents, leaving physicians guessing as to where they could find their patients for post-procedure checks. Now, they know patients will be in one of their assigned bays. Our staff loves how this patient flow model has improved our post-procedure efficiencies. Patients love it, too, because they see a familiar face standing next to them when they wake up.

Jana Beasley, RN, CGRN

4. Scope reprocessing. Sterilization (or high-level disinfection, if sterilization is not possible) of endoscopes is required before each use. Your scope reprocessing protocols should include air-drying and manual cleaning before automated cleaning.
Benchmark: 46% of facilities use automated scope reprocessing; 41% of facilities use manual and automated scope reprocessing.

Work with dedicated endoscopy techs and cross-train medical assistants to assist in scope reprocessing. We assign 2 scope techs to the reprocessing area while a third floats from room to room, breaking down, transporting and setting up scopes between procedures. Covered plastic bins are ideal for containing scopes during transport down long hallways, but our scope reprocessing takes place in an area adjacent to the procedure rooms. To make transporting easier, we bought 15 lunch trays from a restaurant supply store. We place scopes on trays after they're reprocessed, and cover them with a small blue surgical towel that fits perfectly over the scope. The sturdy trays are easy to carry and easy to rinse off and clean between uses.

Michelle Steele, BSN, RN, CGRN
Nurse Administrator
Eastside Endoscopy Center
Bellevue, Wash.
[email protected]

5. Bowel prep. National guidelines suggest you document the quality of patients' bowel preps as one of colonoscopy's quality indicators. Poor bowel preps can interfere with the effectiveness of colonoscopy and could prevent completion of the procedure.
Benchmark: 34% of cases involved excellent preps; 51% of procedures involved good preps; 12% of cases involved fair preps; 3% of cases involved poor preps.

To increase prepping compliance, provide patients with detailed instructions and checklists that correspond to the preps they need to take. Our pre-procedure information packets tell patients to eat a regular breakfast by 10 a.m., and to stay on a clear liquid diet up until midnight, on the day before the procedure. We outline exactly how much prep each dose consists of and when it needs to be taken, and suggest that patients drink — not sip — their doses. They're reminded that they may have nothing by mouth (including mints or gum) within 3 hours of their procedure.

Checklists included in the information packet let patients follow their course of care, from before they arrive at our facility until after they leave. The checklist notes what to bring on the day of the procedure, when to arrive, what medications they can and cannot take and the steps we'll need to complete before they're discharged.

Several years ago, a patient volunteered to make the checklists more user-friendly so they're now helpful tools that are easy to understand and follow. In fact, most patients come in carrying the papers, with notes scribbled on them like worksheets.

Stephanie Diem, RN, BS
Clinical Director
Washington Square Endoscopy Center
Philadelphia, Pa.
[email protected]