A “Scope in Time” Saves Lives: Decreasing GI Lab Wait Times

1. A “Scope in Time” Saves Lives: Decreasing GI Lab Wait Times Team Members: Lynn Heicher, RN, MS, CGRN, CLNC Mary Ann Bungag, RN, BSN, CGRN Rose Lach, RN, PhD Nancy Forcier, RN Forces of Magnetism: Force 7: Quality Improvement Force 11: Nurses as Teachers Force 6: Quality of Care

2. The Problem:GI Lab Capacity • The GI Lab is a high volume procedure area performing routine and specialty procedures for Loyola inpatients and outpatients and an extensive network of outside referrals. • 800-900 procedures per month • 1000+ phone calls per week requesting procedures • The “gold standard” of preventive care suggests a screening colonoscopy for colon cancer detection and prevention at 50 years of age. This population has grown with the aging of the “Baby Boomer” generation. • Patient access for scheduled appointments was 139 days for colonoscopy and EGD. • Patient turnaround time through the GI lab averaged 4 to 6 hours, resulting in numerous patient complaints. Confidential: Quality Improvement Material

3. Project Aim Statement To expand GI Lab capacity by improving patient appointment access and reducing procedure turnaround time. Goals: • Decrease wait time for Colonoscopy and EGD appointments to less than 6 weeks. • Reduce patient turnaround time in GI Lab: • FOCUS: Patient check-in to Pre-op admission less than 60 minutes Confidential: Quality Improvement Material

4. Ownership of the schedule: Realistic time allotments Decreased overbooks Redesigned provider schedules Realistic workload for MD’s Realistic patient flow Added temporary Saturday schedule to reduce backlog GI Lab triage nurse role: Schedule Prioritization Urgent/emergent cases High-tech cases Clinical resource for service reps. Liaison between the patient, provider, PCP/referring MD, and GI lab. Pre procedure phone calls/checklist: Scripts for pre-procedure phone call Improved patient compliance Decreased no shows and ineffective appointments. Solutions: Improved Appointment Access Confidential: Quality Improvement Material

5. Staffing & Training Increased staffing Maintained appropriate patient/nurse ratios Staggered shifts and breaks Cross-trained nurses Pre-procedure Post-procedure Procedure rooms High tech/Interventional procedures Re-structured GI tech role Extensive training, in-services and competencies Endoscope reprocessing Dedicated reprocessing staff Mandatory training – Care and handling of endoscopes New Resources Added a fulltime transporter In-house transports Outpatient escorts to lobby Added volunteers Assist patient and family escorts Update time lines Purchased pagers for family/visitors Enhanced communication & decreased phone calls Allows visitors to use green space & cafeteria Solutions:Improved Patient Flow Confidential: Quality Improvement Material

6. 3 new physicians Jul-Nov 08 Saturday hours Jun 07 – Apr 08

7. 3 new physicians Jul-Nov 08 Saturday hours Jun 07 – Apr 08

8. Staffing/Skill Mix Changes - Jun 07 Triage RN role Feb 07

9. Analysis • Wait times for GI Lab appointments are reduced significantly: • Colonoscopy: 139 days to 47 days (Feb 09) • EGD: 139 days to 47 days (Feb 09) • Improved patient flow - Waiting room to Admission • 87% of patients met the turnaround time goal of 60 minutes or less Factors contributing to our success: • Physician buy-in • Staff collaboration • Administrative support to facilitate staffing needs and acquisition of needed equipment Confidential: Quality Improvement Material

10. Next Steps Transition patient throughput focus to other segments of care Pre-op holding area to procedure room Procedure room to discharge Expansion project planning Create optimal throughput Decrease bottlenecks Optimize satellites for screening procedures Continue to foster staff development by using evidence-based competencies and practice guidelines Confidential: Quality Improvement Material