EFFICIENT ENDOSCOPIES How do you run a successful endo facility?

1 Block scheduling
To keep things moving, block out morning and afternoon shifts for your GI docs. Let's say your facility has 4 procedure rooms. Schedule 4 doctors to come in from 7 a.m. to 12 p.m., and assign each to a room. After an hour lunch break, those 4 doctors leave and 4 more doctors come in for cases from 1 p.m. to 4:30 p.m. Having clearly defined a.m. and p.m. blocks with set start and stop times reduces any delays that arise when doctors shuffle in and out of facilities as they please, says Becky Johnson, RN, clinical director of the Lincoln (Neb.) Endoscopy Center.

"We block-schedule them so they each have 9 to 10 cases, and then they can grab lunch and head to the office," says Ms. Johnson. "It really works well to increase case volume and efficiency."

Another scheduling tip: Instruct patients to arrive 45 minutes before their scheduled appointment to leave enough time for insurance verification, admission paperwork and confirming rides home. Then schedule each colonoscopy for a half-hour time slot. "That seems to be enough time to complete the procedure and turn the room over for the next patient," says Carroll A. Harrell, RN, CAPA, director of the Princeton (N.J.) Endoscopy Center.

2 Patient education
Patients who know exactly what to expect before they set foot in your facility are less likely to arrive for their colonoscopies poorly prepped, which is a leading cause of delays, says Gerry Poitras, RN, BSN, manager of the Advanced Endoscopy Center in Vancouver, Wash. He says that after his center schedules a patient for a colonoscopy, staff asks the patient to come in for an in-office meeting where they dole out instructions. Then staff members call the patient both 4 days before the procedure and the morning before to ensure he understands how to do the bowel prep and that he has a driver in place.

In addition to mailing patients a packet of information, the Lincoln Endoscopy Center also posts prepping instructions on its website (gidocs.net) for download. "Patients are very keen to the internet and looking stuff up now," says Ms. Johnson. "When docs get that call that the patient needs more information or he lost his packet, the doctor can simply guide him to the website. This has really helped cut down on our late night calls."

And when it's time for patients to leave your facility, don't just hand them a sheet of discharge instructions and send them on their way. Instead, have staff explain — in detail — what exactly they're doing, and what the patient can expect next. It may take some additional time on the front end, but it can boost your overall efficiency, says Ms. Harrell. "People are more confident to leave and go home when they have instructions in their hands and they feel like they know what to expect," she says.

3 Sedation
While some GIs insist on propofol, others prefer the standard conscious sedation combination of midazolam and fentanyl. Mr. Poitras says the decision comes down to the patient's ASA score — those with scores of 3 or higher receive propofol while healthier patients receive conscious sedation.

Ms. Harrell says almost all colonoscopies are done under propofol sedation. Not only do patients recover more quickly, but it frees up endoscopists to focus on the scope rather than the anesthetic. "Patients don't wake up with that 'hangover' that can happen with other sedation methods. It makes a huge difference," she says.

Ms. Johnson says that most of her docs use conscious sedation. Though the medications don't kick in as quickly as propofol, she feels they have several advantages. "A lot of centers are moving to 100% propofol," she says, "but it adds costs and our patients do fine with conscious sedation."

4 Scope technology
The latest colonoscopes with HD or 4K images, 330-degree views of the colon and enhanced colorization let physicians quickly and easily spot polyps during screenings, says Ms. Johnson. To give her physicians the best technology without a big capital outlay, Ms. Johnson says her center has a leasing agreement that lets them swap outdated equipment for new, modern technology every few years. "The pictures are better, there's better maneuvering and it makes cases much more efficient," she says. "Plus, it makes our doctors happy."

5 Scope reprocessing
Most endoscopy centers use automated scope washers, but it's important that you properly train the staff members using the washers, says Ms. Harrell, who notes that all of her techs are state-certified. Ms. Johnson suggests employing techs that are solely responsible for scope reprocessing. "The more you do something, the better you get at it," she says. "But I don't have just one person doing scope after scope. Instead we rotate the job among the techs, so that they can take a break. It improves their satisfaction with their job."

Ms. Johnson says her center also holds regular competency exams, brings in the scope's manufacturers once a year for training and audits the entire reprocessing protocol every 6 to 12 months to check that everything is running efficiently and effectively. Mr. Poitras adds that his center also does monthly proficiency checks, using a tiny scope to look inside the cleaned scopes' lumens for any missed bioburden. "We do one random scope per month, per tech," he says.

6 Success stories
If you're struggling to improve your colonoscopy services, don't hesitate asking for a little help, says Ms. Johnson. "I think it's important to go look at other successful centers and see how they're run," she says. "If you're a center that's struggling, go tour another one. Throw your ideas out there to the managers and learn from them. Don't be afraid to bring back some ideas that can help you improve." OSM