HA540 Unit 3 Endoscopy Recovery Flow Analysis Example

Fifteen Patients for Twelve Recovery Bays at 09:45: A Patient Flow Analysis of a Single Tuesday at a Composite Hospital Endoscopy Unit, Showing That the Rooms Wait on Recovery and Testing a Staggered Start Template

[Student Name]

Purdue University Global

HA540: Health Care Operations and Quality Assessment

Unit 3 Patient Flow Analysis

[Instructor Name]

[Date]

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

The Question

Physicians complain that rooms "turn slowly." The unit's own data show room turnover near its target. This analysis asks where the time actually goes, following the whole flow from pre-procedure bay to recovery and discharge.

Capacity Before Timing

The unit has [12] recovery bays open [600] minutes a day, [7,200] bay-minutes. Recovery demand on the sample day: [38] routine patients at about [40] minutes each and [eight] advanced patients at about [70], [2,080] bay-minutes in total, or [29] percent of capacity. Across the day, there is far more recovery space than patients need. The problem is when they arrive in it.

How the Day Was Rebuilt

I took one ordinary Tuesday from the scheduling system, with booked start times, actual room-in and room-out times, recovery arrival and discharge for every patient. Each patient's recovery stay was placed on a grid of fifteen-minute blocks from [07:30] to [18:30], and the number of patients in recovery was counted block by block. The same grid was then rebuilt under the new template, keeping every patient's actual procedure and recovery length so that only the start times changed. A Tuesday was chosen because the nurse manager judged it typical; a Monday, with more add-on cases from inpatient floors, would show a sharper peak.

Demand in Fifteen-Minute Blocks

Because all six rooms start at [07:30] and routine cases finish within about half an hour, six patients enter recovery between [08:00] and [08:15], six more by [08:45] and so on. Recovery demand rises above twelve in [seven] of [40] blocks, peaking at [15] around [09:45]. Hourly counts would hide this, because an hour that averages ten patients can contain a quarter-hour of fifteen. The unit does not run short of recovery bays across the day; it runs short for about two hours every morning. When no bay is free, the patient stays in the procedure room under nurse observation, a "room hold." On the sample day, room holds totaled [214] minutes, enough room time for about [five] routine procedures. Physicians see a room that is not ready and call it slow turnover. Simulation studies of colonoscopy suites show the same interaction: adding procedure rooms does little if recovery capacity and arrival times do not match them, while changing the schedule can raise throughput with no new space (Berg et al., 2010).

Pre-Procedure Bays

The [eight] pre-procedure bays fill at [07:00] and empty in a rush as all rooms call their first patients. Late-arriving patients for second cases then wait in the lobby until bays free up, which is part of why the loops found in Unit 2 caused such long delays.

The Redesigned Template

Rule 1: stagger room starts in pairs at [07:30], [08:00] and [08:30]. Rule 2: place advanced cases, which have longer recovery, at the start of the fluoroscopy rooms' days, so their recovery overlaps the quieter early period. Rule 3: cap new recovery arrivals at [three] in any fifteen-minute block, so nurses can complete handoffs safely. Rule 4: book short routine cases to fill gaps late in the day.

Results on Four Measures

Peak recovery demand: [15] before, [12] after. Blocks over capacity: [seven] before, [zero] after. Room-hold minutes: [214] before, about [18] after, from a single advanced case that overran. Last discharge: [18:05] before, [17:50] after, because rooms no longer wait for recovery. The staggered start means the last two rooms run to [17:30] or a little past, which requires adjusting the schedules of [two] nurses and the physicians assigned to those rooms. A study of an endoscopy center serving low-income patients found that changing the schedule and staffing pattern improved flow more cheaply than adding rooms (Day et al., 2014).

What Physicians Lose

Physicians assigned to later starts lose an early finish on those days. Rotating the late rooms among physicians spreads that cost. Some physicians with clinic afternoons may need to keep early starts, which the template can allow for one pair of rooms.

Limits

Real days bring add-on cases from inpatients, cancellations and procedures that run long. The template should hold back about [30] minutes of slack at mid-morning. Recovery times vary with sedation type; patients with deep sedation by anesthesia staff take longer, which the template treats as advanced. One day was modeled in detail; the pattern should be checked over a month of data before the template is adopted.

Recommendation

Test the staggered template for [four] weeks, measuring room holds and recovery peak daily, before making it permanent. Measurement over time, rather than a single day's comparison, will show whether the gain holds (Langley et al., 2009).

Conclusion

The rooms are not slow; they are waiting for recovery. The fix is mostly when patients are booked, not how many bays the unit has.

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.