High-volume GI facilities run on hard work and smart ideas, and our busy endoscopy center is no different. We're always considering new solutions to improve how quickly and safely we perform cases and reprocess our fleet of endoscopes. The method we use to insufflate colonoscopy patients is one of the most effective ways we've improved patient care, saved money and kept our center running like a well-oiled machine.

We knew that using carbon dioxide instead of air for insufflation provided a patient benefit, but during a 2017 trial we also discovered it offered a financial advantage. Carbon dioxide, with its ability to improve a colonoscopy screening's efficiency, also increased our patient satisfaction scores and the time savings we realized allowed us to pay for switching to gas within a year.

Despite it being fairly well known in the industry that using CO2 to insufflate colonoscopy patients improves their comfort, it's not yet the standard practice in all facilities. One factor contributing to this is its higher cost. In our facility, physicians were split among those who wanted to use CO2 and those who weren't sure if it was worth the added expense. That's why we conducted a trial to detail how CO2 insufflation impacted patient care and exactly how much extra it cost us to implement the practice.

To run the trial, we took one of our three procedure rooms and dedicated it as the CO2 room. Patients receiving colonoscopies in this room were given CO2 insufflation, while those in our other two rooms received air insufflation. Not only did this let us compare CO2 patients to our control group, but it also gave us a good idea of how many tanks we would go through per room, how long the tanks would run and what the major differences were in the systems we trialed.

When deciding which insufflator and tanks to use, we spoke with three manufacturers to determine which one would be the best one for the trial, and eventually, to use full time. One of the key factors was the cost of associated supplies. The necessary tubing can be reprocessed or disposable. We decided to go with a manufacturer that used reusable tubing because it would result in a major cost savings.

We also looked at the cost of the insufflator and CO2 tanks, which run $7 to $8 each. Depending on how long the procedure lasts, we can get 15 to 20 cases out of a single tank. When we did the math, adding CO2 cost less than 50 cents per patient. Determining which vendor to use wasn't only about cost, however. It was important for us to know how vendors responded to service calls and the support they could provide our staff.

We decided to run the trial for a month. We compared data about recovery time and patient comfort from both the CO2 and air insufflation groups. During the trial, a total of 272 patients were assessed, with 91 receiving CO2 insufflation and 163 getting air insufflation. In 18 cases, the documentation was unclear on whether a patient received air or CO2, or if a tank ran out during the procedure, so those patients were excluded from the study

We've also implemented a few other practices that have improved patient satisfaction and boosted the efficiency of our facility. Initially, when we ran the first trial testing CO2 insufflation, we were using a standard care model for our endoscopy center that included having an admission nurse, procedure nurse and recovery nurse care for patients. However, we have since found that switching to a primary care model, which involves the admission nurse traveling with the patient all the way through the procedure to recovery. This means all staff are trained in all areas, a practice that allows for more staffing flexibility. Additionally, patients appreciate being cared for by a single nurse throughout their stay.

Our scope handling practices help to improve our overall efficiencies, but, more importantly, they ensure our patients receive the safest care possible. Scopes are flushed and wiped down at the patient's bedside, and transported to the reprocessing area in a sealed, labeled container. Our reprocessing techs are diligent in their manual cleaning methods, ensuring the correct-sized brush is used to scrub away bioburden in internal channels. The scopes are run through an automatic endoscope reprocessor and the internal channels are flushed with alcohol to promote drying before the scopes are hung in storage.

Your reprocessing techs likely know the basics of proper endoscope care, but they might not be aware of the little things they can do to improve their practices. Our endoscope manufacturer sends a rep out twice a year to observe our scope handling practices, from bedside to storage. The rep is very knowledgeable and provides our staff with useful, constructive advice. They appreciate his feedback and tell me it helps them improve their practices or confirms they're doing everything correctly. The rep lives four hours away from our center, but says he'd gladly make the trip for his own colonoscope screening because he knows our reprocessing techs take meticulous care of our scopes. Efficiency is essential in an endoscopy center, but feedback like that is even more important. OSM