Leveling Up: Using Lean to Improve Turn Over Time and Increase Daily Procedure Volumes

Objectives: Describe factors that inhibit endoscopy room productivity and list implementations to decrease room turn over time (TOT).
Background: Efficient room utilization and productivity are key in ensuring patient access, capacity, and revenue for ASCs. In 2021, from March to September, Apple Hill Surgical Center (AHSC) averaged 10 daily gastroenterology procedures per room using three endoscopy rooms. This rate of utilization was below target. While exploring possible variables affecting room utilization, the first noticeable factor was unreliable and inaccurate patient scheduling, as evidenced by lack of standard work. Critical variables including TOT, non-productive in-room time, individual provider or patient factors, and high patient reschedule/cancellation rates, were not considered when scheduling patients. There was a lack of prior data available to support the average case length. Also, no baseline metrics or process for in-room non-procedure work, and standards for room preparation were available.
Project description: In January 2022, an interdisciplinary team comprised of members from AHSC, digestive health, corporate lean advisors, schedulers, and system application analysts met to undertake a lean collaborative. Waste was identified and the team brainstormed ideas on countermeasures, which included tasks or changes categorized to either aid in implementing new and accurate provider scheduling templates or assist in creating lean processes and efficient standards for room TOT and non-procedural time.
Project goals: The goal of these countermeasures is to utilize AHSC’s endoscopy rooms to their full capacity corresponding with operational hours. When all three procedure rooms are operational for the duration of the day, each room will complete 15 procedures with nine in the morning and six in the afternoon. To meet this end goal, targets were put in place to keep the implementations on track. These targets were to be met by March 2022 and included improving daily utilization to average 15 daily procedures, reducing TOT from 14 minutes to 10 minutes and reducing in-room non-procedure time from nine minutes to five minutes per case.
Evaluation/results : In March 2022, the results were analyzed to determine if the project was on track. Daily utilization of rooms on average was 12.62 procedures, which was a 26% increase. The length of TOT decreased to 13 minutes, which shows a 7% improvement, and the in-room non-procedure time decreased to 8 minutes per case, indicating an 11% improvement. From this data, the team identified additional tasks to continue improvement to meet the facilities' full capacity and utilization goal. Results were again analyzed and reviewed on a monthly basis showing continued improvement.
Implications for nursing: Interdisciplinary collaborations are key in improving an ASC’s productivity. Nurses must assess and be aware of modifiable variables that impact TOT and ways to decrease waste in processes. Through open communication among physicians, advanced practice providers, anesthesiologists and nursing staff, along with other crucial personnel who impact endoscopy room utilization, these variables can be modified to improve patient access, capacity, and revenue.