PTU-081 Enhancing efficiency in endoscopy unit using the ‘time and motion’ model

Introduction Endoscopy Units throughout the UK are facing unprecedented pressures due to increasing demand with limited capacity. Our aim was to explore strategies to improve our endoscopy unit’s efficiency. In order to identify targets for improvement we sought to undertake a ‘Time and Motion’ study in the endoscopy unit. Methods The study was conducted at Nottingham City Hospital Endoscopy centre between 13th January 2017 to 10th February 2017. Procedures included were gastroscopy, colonoscopy, sigmoidoscopy, bronchoscopy, therapeutic endoscopy and endoscopic ultrasound. From the time a patient reports to the reception to the time discharge was made the patients journey was mapped using the ‘time and motion’ principle. As part of this study, healthcare professionals and admission staff were asked to record the patient’s journey through endoscopy unit accurately and complete templates which were kept with the patient’s notes as they moved through the unit. Separate independent observers were then responsible for observing and recording times at which patients entered and exited the procedure room coupled with noting any issues for delays. Results A total of 509 day case patients and 27 inpatient procedures were performed in 4 procedure rooms during the study period over 138 endoscopy lists. The adjusted median delay in starting time was 26 minutes with a peak of 20 minutes. The adjusted median turnaround times (time period between exit of patient from endoscopy room to entry of next patient in to the room) was 13:11 minutes with a peak at 12:30 minutes. The median for overruns (overrunning of lists beyond schedule) was 49:00 minutes. The adjusted median procedure time was 25:00 minutes. 95% of endoscopy lists started late and 80% of the lists finished late. Bottlenecks identified were (1) delays in booking, (2) delays in patient preparation including enema, (3) inpatient transportation from and to wards and (4) timely endoscope availability. These were addressed by changing patient arrival times, additional support workers to support admission and patient preparation, introduction of co-ordinator to monitor lists with empowerment to redeploy staffing, and the role of a ‘runner’ to liaise between decontamination and the procedure rooms. Conclusion The ‘time and motion’ study is a useful tool to identify areas for improvement in patient flow and improve efficiency in the Endoscopy unit.