HA540 Unit 10 Endoscopy Throughput QI Proposal Example

From 182 Minutes to 128: A Two-Phase Quality Improvement Proposal for a Composite Hospital Endoscopy Unit, Funding a Pre-Call Nurse and a Room Technician Only After a No-Cost First Phase Proves Itself

[Student Name]

Purdue University Global

HA540: Health Care Operations and Quality Assessment

Unit 10 Quality Improvement Proposal

[Instructor Name]

[Date]

The unit, the budget and every figure are composite and bracketed for the writer's own data.

Problem Statement

In the last fiscal year, the unit performed about [11,000] procedures in six rooms. The median outpatient spent [182] minutes from arrival to discharge, of which [90] were waiting. The last patient left at a median of [18:05], [35] minutes after the scheduled close, producing [1,460] overtime hours for nurses and technicians, about [$105,120] at time-and-a-half. Procedure rooms were held for recovery a median of [214] minutes a day, time that could have served about [five] more patients. The wait for a screening colonoscopy is [nine] weeks. The earlier units of this course located the causes: checks done on the morning of the procedure that send staff back to the phone (Unit 2), all rooms starting together so recovery overflows (Unit 3), a morning rush that outpaces bay nurses (Unit 4) and room turnovers done in sequence (Unit 7).

Aim

Reduce the median time from arrival to discharge for outpatients from [182] to [150] minutes by the end of [quarter one] and to [128] by the end of [quarter two], without increasing overtime or reducing cleaning checklist completion.

Driver Diagram

Primary driver 1: records complete before arrival. Secondary: escort confirmed, blood thinner instructions clear, history current. Change ideas: nurse pre-call two business days before; required fields in the record. Primary driver 2: recovery flow leveled. Secondary: staggered room starts; advanced cases early in fluoroscopy rooms. Change idea: the template tested in Unit 3. Primary driver 3: room turnover shortened. Secondary: tasks done outside the turnover. Change idea: a prepared second cart and pre-labeled containers, tested in Unit 7. Primary driver 4: bay nursing matched to the morning rush. Secondary: arrival times spread; a recovery nurse starting early. Change idea: the leveling tested in Unit 4. Every change idea on the diagram has already been tested at small scale; this proposal is about spreading what worked.

Phase One: No New Cost

Spread the staggered template to all six rooms; adopt turnover standard work in all rooms, staffed by existing technicians where possible; make required fields live; move one recovery nurse's start to [06:45]. Expected result: median [150] minutes. Owner: nurse manager. Duration: one quarter. Phase one relies on existing staff. The pre-call will be done by bay nurses in quiet afternoon hours, which limits it to about half of patients.

Phase Two: Conditional Funding

Funding for phase two is released only if phase one reaches [150] minutes, or documents why it did not and what phase two would change. Pre-call nurse, [0.6] full-time equivalent at [$104,000] loaded: [$62,400]. Room technician, [0.6] full-time equivalent at [$58,000] loaded: [$34,800]. Two-way text reminder service: [$4,200]. Total: [$101,400] a year. The pre-call nurse reaches every patient; the technician lets the turnover standard run in all rooms on every shift. Expected result: median [128] minutes.

Savings, Claimed Conservatively

Only [60] percent of overtime cost is counted as saved, [$63,072], because some late finishes come from emergencies no schedule can prevent. The additional capacity, about [five] procedures a day, is reported but not counted as savings, since filling it depends on referrals and payer mix. Net cost after counted savings: about [$38,328] a year.

What Patients Told Us

Before writing this proposal, the patient adviser and I read [120] comments from the unit's last two quarters of patient surveys. The most frequent complaint was not pain or comfort but time: long waits in the lobby while fasting, and not knowing why a procedure booked for [08:30] began at [10:00]. Escorts complained of being told to return at one time and then waiting an hour more. Several patients said they would have welcomed a call before the day to check their instructions. These comments matched the measured waits closely, which gives the aim a plain meaning for patients: less time fasting in a waiting room, and a pickup time that holds.

Stakeholder Readiness

The charge nurses and technicians who ran the small tests support spreading them and have asked to lead the training. Two endoscopists are enthusiastic; three are neutral and want to see the effect on their finish times first; one opposes later starts on clinic days, and the template allows an exception for that physician. Anesthesia staff need notice of the new start times to adjust their own schedules, which phase one includes. Finance supports phase two only on the condition already built into this proposal.

Measurement Plan

Aim measure: median arrival-to-discharge time for outpatients, weekly. Process measures: share of patients entering any morning loop; median room turnover; room-hold minutes per day. Guardrails: overtime hours per pay period; cleaning checklist completion; unplanned admissions after outpatient procedures. All measures will be shown on run charts with the start of each phase marked and judged by the rules for detecting real change rather than by comparing single weeks (Provost & Murray, 2011).

Evidence That the Approach Works

Simulation studies of endoscopy units show that schedules and staffing patterns, rather than more rooms, are the main levers on throughput and patient time in the unit (Berg et al., 2010; Day et al., 2014). The proposal follows the model for improvement: an aim, measures and changes tested before spread (Langley et al., 2009).

Governance

Sponsor: director of procedural services. Lead: endoscopy nurse manager. Team: charge nurses, a technician, a scheduler, two endoscopists, an anesthesia representative, a quality specialist and a patient adviser. The team meets every two weeks; the sponsor reviews monthly.

Risks and Responses

Physicians may resist later start times; rotation shares the burden. Patients may not answer the pre-call; texts and a second call follow. Staff may see the turnover standard as speed pressure; the cleaning checklist is a guardrail, and any decline pauses the spread.

Sustainment

The template, turnover standard and pre-call script become standard work, with a monthly review of the aim and guardrail measures. If the median rises above [150] minutes for four consecutive weeks, the team reopens the analysis.

Limitations

Baseline figures come from one year; seasonal shifts in volume could move them. The expected results are estimates from small tests. Recovery times vary with sedation type, which the template handles only roughly.

Conclusion

The unit's long days come from timing, not space. Two staged phases, the first free and the second earned, should cut patient time by about an hour and end most late finishes.

References

Berg, B., Denton, B., Nelson, H., Balasubramanian, H., Rahman, A., Bailey, A., & Lindor, K. (2010). A discrete event simulation model to evaluate operational performance of a colonoscopy suite. Medical Decision Making, 30(3), 380-387. https://doi.org/10.1177/0272989X09345890

Day, L. W., Belson, D., Dessouky, M., Hawkins, C., & Hogan, M. (2014). Optimizing efficiency and operations at a California safety-net endoscopy center: A modeling and simulation approach. Gastrointestinal Endoscopy, 80(5), 762-773. https://doi.org/10.1016/j.gie.2014.02.1032

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Provost, L. P., & Murray, S. K. (2011). The health care data guide: Learning from data for improvement. Jossey-Bass.