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M Laryea, D Leddin, DM Farina

Department of Medicine, Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia

PURPOSE: The purpose of this report is to present the results of changes to scheduling of endoscopies to unit utilization and efficiency.

BACKGROUND: Demand for endoscopy services is high and supply of time for endoscopy is limited. Therefore it is important that available time be used efficiently. At the QEII in Halifax we perform 7,000 procedures annually. Physicians perceived that the unit was underutilized relative to staffing and that they had difficulty getting adequate scope time. We hypothesized that utilization of an endoscopy unit could be improved by determining and improving on key areas of inefficiency based on an audit of the units activities.

METHODS: A retrospective audit of endoscopy utilization for a typical month in 2002 was performed. We collected data on the total time used, percent of utilization by time of day as well as designation. Endoscopy time could be either designated to specific users in a block or non-designated and available to whomsoever wanted it. Based on the survey months data we applied three changes. Utilization of the unit was compared pre and post intervention.

RESULTS: Prior to change 250 colonoscopies, 248 gastroscopies and 55 flexible sigmoidoscopies were performed in a single month. Compared to available time only 67% of endoscopy time was actually used. The lowest utilization was of unassigned time, 44% of endoscopy time which was not designated to an individual physician was unused. Three changes were instituted. Increasing blocks of time were assigned to high volume users, the number of unassigned slots were decreased, vacancies in the schedule were communicated to all users, and secretaries, two months in advance. Comparison with a control month after these changes has shown that utilization has increased from 60% to 81%. No increase in nursing hours has been required.

CONCLUSION: Audit of an endoscopy unit can reveal significant unused resources. Focusing on high volume users, decreasing unassigned time and communicating better, can increase efficiency. A 20% increase in utilization can be achieved with no increase in nursing costs.

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