A Scope in Time Saves Lives Decreasing GI

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, Ph. D Nancy Forcier, RN Forces of Magnetism: Force 7: Quality Improvement Force 11: Nurses as Teachers Force 6: Quality of Care

The Problem: GI Lab Capacity ½ 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. ½ ½ 800 -900 procedures per month 1000+ phone calls per week requesting procedures ½ 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. ½ Patient access for scheduled appointments was 139 days for colonoscopy and EGD. ½ Patient turnaround time through the GI lab averaged 4 to 6 hours, resulting in numerous patient complaints. Confidential: Quality Improvement Material

Project Aim Statement To expand GI Lab capacity by improving patient appointment access and reducing procedure turnaround time. Goals: ½ ½ Decrease wait time for Colonoscopy and EGD appointments to less than 6 weeks. Reduce patient turnaround time in GI Lab: ½ FOCUS: Patient check-in to Pre-op admission less than 60 minutes Confidential: Quality Improvement Material

Solutions: Improved Appointment Access Ownership of the schedule: ½ Realistic time allotments ½ ½ ½ Realistic workload for MD’s Realistic patient flow Added temporary Saturday schedule to reduce backlog Schedule Prioritization ½ Decreased overbooks Redesigned provider schedules ½ GI Lab triage nurse role: ½ ½ ½ 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: ½ Scripts for pre-procedure phone call ½ ½ Improved patient compliance Decreased no shows and ineffective appointments. Confidential: Quality Improvement Material

Solutions: Improved Patient Flow Staffing & Training New Resources ½ ½ Increased staffing ½ ½ ½ Pre-procedure Post-procedure Procedure rooms High tech/Interventional procedures Re-structured GI tech role ½ ½ ½ Cross-trained nurses ½ ½ Maintained appropriate patient/nurse ratios Staggered shifts and breaks Added a fulltime transporter Added volunteers ½ ½ ½ In-house transports Outpatient escorts to lobby Assist patient and family escorts Update time lines Purchased pagers for family/visitors ½ ½ Enhanced communication & decreased phone calls Allows visitors to use green space & cafeteria Extensive training, in-services and competencies Endoscope reprocessing ½ ½ Dedicated reprocessing staff Mandatory training – Care and handling of endoscopes Confidential: Quality Improvement Material

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

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

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

Analysis ½ Wait times for GI Lab appointments are reduced significantly: ½ ½ ½ Colonoscopy: 139 days to 47 days (Feb 09) EGD: 139 days to 47 days (Feb 09) Improved patient flow - Waiting room to Admission ½ 87% of patients met the turnaround time goal of 60 minutes or less Factors contributing to our success: ½ ½ ½ Physician buy-in Staff collaboration Administrative support to facilitate staffing needs and acquisition of needed equipment Confidential: Quality Improvement Material

Next Steps ½ Transition patient throughput focus to other segments of care ½ ½ ½ Expansion project planning ½ ½ Pre-op holding area to procedure room Procedure room to discharge 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