title: Potential impact of enhanced practice efficiency on endoscopy waiting times.
abstract: BACKGROUND
  With the growing demand on endoscopy services, optimising practice efficiency has assumed increasing importance. Prior research has identified practice changes, which increase the efficiency in endoscopy. In this study, the potential impact of these practice changes on the current and projected future endoscopy waiting times at our institution was assessed.
  
  
  METHODS
  The annual volume of endoscopic procedures performed at a major teaching hospital and the annual procedure demand from 2000 to 2007 were reviewed. Procedure demand and waiting times were projected until 2012. The impact of three practice changes, which have been shown to increase efficiency was assessed: 1. routinely obtaining i.v. access and consent in patients prior to endoscopy (approach 1); 2. routinely obtaining i.v. access and consent, and sedating the patient prior to endoscopy (approach 2); 3. utilizing a two-room per endoscopist model (approach 3).
  
  
  RESULTS
  There has been a significant increase in annual procedure volume (36%) and annual procedure demand (69%) from 2000 to 2007. Annual waiting times for routine procedures have lengthened, from 6 weeks (2000) to 22 weeks (2007). Assuming continued linear growth in demand up to 2012, the projected waiting times will continue to rise reaching 40 weeks in 2012. Routinely obtaining i.v. access/consent prior to procedure (approach 1) would shorten the average routine waiting times so that 8 weeks (recommended HSE maximum) would not be exceeded until early 2006; routinely obtaining i.v. access/consent and sedating patient prior to procedure (approach 2) would shorten the average routine waiting time so that 8 weeks would not be exceeded until 2008; utilising two rooms per endoscopist (approach 3) would shorten the average routine waiting time so that 8 weeks would not be exceeded until early 2012.
  
  
  CONCLUSIONS
  Maintaining timely access to endoscopic services is becoming more challenging in the face of growing demand. Modifications in routine clinical practice can significantly impact procedure waiting times. In an era where economic aspects of medical care are becoming increasingly important and where there is growing focus on waiting times as a measure of clinical performance, these findings underscore the importance of providing clinical care in the most efficient manner possible.
authors.affiliation: Department of Gastroenterology and Hepatology, Beaumont Hospital, Dublin, Ireland. harewood.gavin@gmail.com
authors.forename: G C
authors.initials: GC
authors.lastname: Harewood
authors.forename: H
authors.initials: H
authors.lastname: Ryan
authors.forename: F
authors.initials: F
authors.lastname: Murray
authors.forename: S
authors.initials: S
authors.lastname: Patchett
mesh_terms: D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004526:Efficiency; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007494:Ireland; D011216:Practice Management, Medical / Q000706:statistics & numerical data*; D013997:Time Factors; D014850:Waiting Lists