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. Solutions: Improved Appointment Access 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. Confidential: Quality Improvement Material

5. Solutions: Improved Patient Flow 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 Confidential: Quality Improvement Material

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

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

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