title: Optimizing efficiency and operations at a California safety-net endoscopy center: a modeling and simulation approach.
abstract: BACKGROUND
  Improvements in endoscopy center efficiency are needed, but scant data are available.
  
  
  OBJECTIVE
  To identify opportunities to improve patient throughput while balancing resource use and patient wait times in a safety-net endoscopy center.
  
  
  METHODS
  Safety-net endoscopy center.
  
  
  METHODS
  Outpatients undergoing endoscopy.
  
  
  METHODS
  A time and motion study was performed and a discrete event simulation model constructed to evaluate multiple scenarios aimed at improving endoscopy center efficiency.
  
  
  METHODS
  Procedure volume and patient wait time.
  
  
  RESULTS
  Data were collected on 278 patients. Time and motion study revealed that 53.8 procedures were performed per week, with patients spending 2.3 hours at the endoscopy center. By using discrete event simulation modeling, a number of proposed changes to the endoscopy center were assessed. Decreasing scheduled endoscopy appointment times from 60 to 45 minutes led to a 26.4% increase in the number of procedures performed per week, but also increased patient wait time. Increasing the number of endoscopists by 1 each half day resulted in increased procedure volume, but there was a concomitant increase in patient wait time and nurse utilization exceeding capacity. By combining several proposed scenarios together in the simulation model, the greatest improvement in performance metrics was created by moving patient endoscopy appointments from the afternoon to the morning. In this simulation at 45- and 40-minute appointment times, procedure volume increased by 30.5% and 52.0% and patient time spent in the endoscopy center decreased by 17.4% and 13.0%, respectively. The predictions of the simulation model were found to be accurate when compared with actual changes implemented in the endoscopy center.
  
  
  CONCLUSIONS
  Findings may not be generalizable to non-safety-net endoscopy centers.
  
  
  CONCLUSIONS
  The combination of minor, cost-effective changes such as reducing appointment times, minimizing and standardizing recovery time, and making small increases in preprocedure ancillary staff maximized endoscopy center efficiency across a number of performance metrics.
authors.affiliation: Division of Gastroenterology, San Francisco General Hospital and Trauma Center, San Francisco, California, USA; GI Health Outcomes, Policy and Economics (HOPE) Research Program and Center for Innovation in Access and Quality (CIAQ), Department of Medicine, University of California, San Francisco, California, USA.
authors.forename: Lukejohn W
authors.initials: LW
authors.lastname: Day
authors.affiliation: Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California, USA.
authors.forename: David
authors.initials: D
authors.lastname: Belson
authors.affiliation: Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California, USA.
authors.forename: Maged
authors.initials: M
authors.lastname: Dessouky
authors.affiliation: Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Hawkins
authors.affiliation: Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hogan
mesh_terms: D001071:Appointments and Schedules; D002140:California; D017598:Efficiency, Organizational; D016145:Endoscopy, Digestive System; D006801:Humans; D017146:Models, Organizational; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D064876:Safety-net Providers / Q000458:organization & administration*; D013997:Time Factors; D013996:Time and Motion Studies