Inefficiencies in the endoscopy suite cause frustration for physicians, hospital administrators, staff, and patients. Turnover time (TOT), the time between one case ending and another beginning, is subjectively disproportionate between various team members. We aimed to define perceptions of TOT and target steps within the process to improve efficiency. This was a prospective cohort study at a tertiary center outpatient endoscopy unit. Phase I aimed to identify the TOT process components based on time stamps in the electronic medical record (N = 686). We defined gastroenterologist perceived TOT (pTOT), anesthesia pTOT, and standard TOT (sTOT). TOT length was calculated for each subgroup. Patient transport was identified as an intervenable target. In Phase II, the task of patient transport moved from the anesthesiology team to endoscopy nurses. Mean TOT and proportion of cases with sTOT <15 minutes’ preintervention (n = 2192) and postintervention (n = 292) were compared. Seven key TOT components were identified that explain variations in pTOT. Average anesthesia pTOT was 15 minutes, whereas average gastroenterologist pTOT was 34 minutes (25.9% vs 57.2% of case length; = .0007). In Phase II, mean sTOT improved from 18.51 to 14.25 minutes ( < .0001), and proportion of sTOT within 15 minutes improved from 41.79% to 58.90% ( < .0001). This intervention saved 45 minutes per room per day, allowing for a revenue potential of more than $300,000 per year per procedure room. This study defines variations in TOT and shows that finding imbalances and sharing the workload significantly cuts costs and improves the overall efficiency of the different subgroups in the turnover process.

中文翻译：

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提高内窥镜套件的效率：集成团队工作流程可提高生产力并最大限度地降低成本


内窥镜套件的低效率给医生、医院管理人员、工作人员和患者带来挫败感。周转时间 (TOT)，即一个案例结束与另一个案例开始之间的时间，主观上在各个团队成员之间是不成比例的。我们的目标是定义对 TOT 的看法以及流程中提高效率的目标步骤。这是在三级中心门诊内窥镜检查中心进行的一项前瞻性队列研究。第一阶段旨在根据电子病历中的时间戳识别 TOT 流程组件 (N = 686)。我们定义了胃肠病学家感知的 TOT (pTOT)、麻醉 pTOT 和标准 TOT (sTOT)。计算每个亚组的 TOT 长度。患者转运被确定为可干预的目标。在第二阶段，患者转运的任务从麻醉科团队转移到内窥镜护士身上。比较了干预前 (n = 2192) 和干预后 (n = 292) 的平均 TOT 和 sTOT < 15 分钟的病例比例。确定了七个关键的 TOT 成分来解释 pTOT 的变化。平均麻醉 pTOT 为 15 分钟，而胃肠科医生平均 pTOT 为 34 分钟（病例长度的 25.9% vs 57.2%；= .0007）。在第二阶段，平均 sTOT 从 18.51 分钟改善至 14.25 分钟 ( < .0001)，15 分钟内 sTOT 的比例从 41.79% 改善至 58.90% ( < .0001)。这种干预措施每天为每个手术室节省 45 分钟，从而使每个手术室每年的收入潜力超过 300,000 美元。这项研究定义了 TOT 的变化，并表明发现不平衡和分担工作量可以显着降低成本并提高流动过程中不同小组的整体效率。