687 - Decreasing Average Upper Endoscopy Wait Times from Order Creation to Finalization in a Tertiary Pediatric Outpatient Endoscopy Unit

Publication Number: 4672.687

Narendra B. Vadlamudi, Virginia Commonwealth University School of Medicine, Glen Allen, VA, United States; Anna C. Harrel, Children's Hospital of Richmond at VCU, New Kent, VA, United States; Kristin A. Shadman, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Background: Upper gastrointestinal diseases are common in children and often require Upper endoscopy (Esophagogastroduodenoscopy, (EGD)) for early diagnosis and treatment. Prolonged wait times for an EGD not only lead to delayed diagnosis but also can significantly increase patient anxiety and negatively impact, clinical outcomes and patient/parent satisfaction. At our institution, we identified a wait time of 79 days from placing the order for outpatient EGD to completion of the procedure.

Objective: The aim of this quality improvement (QI) project was to decrease average wait time for an EGD in children between 1- 18 years by 25% within a 12-month intervention period.

Design/Methods: Using the model for improvement, a key stakeholder team consisting of endoscopy nurse, scheduler, perioperative unit nurse manager, anesthesia coordinator and medical director of endoscopy reviewed existing processes at our institution. A fish bone diagram was developed to identify potential errors in the electronic ordering process and barriers to scheduling EGD. A key driver diagram was constructed with potential interventions to address barriers in the scheduling process (figure 1). Using Plan-Do-Study-Act (PDSA) methodology, interventions included: 1) Standardizing EGD procedure scheduling process to limit scheduling errors (figure 2), 2). Implementing a new electronic order set to prioritize patients based on clinical symptoms and urgency and 3). Introducing a new patient reminder system using phone calls and electronic messaging to reduce no-shows and late cancellations.
Outcome measures were time from order placement to procedure tracked on an XMR chart and same day cancellation rates tracked on a SPC C-chart. Balancing measure was provider and patient satisfaction with the new scheduling process.

Results: A significant decrease in EGD average wait time from 79 days to 25 days was observed (figure 3a). Same day cancellation rate also decreased from 7% to 3% (figure 3b). No significant disparities across sex, race and age groups were noted with a similar decline in waiting times across groups. Patient and provider satisfaction rates regarding timeliness of EGD procedure completion, have improved.

Conclusion(s): Standardizing procedure scheduling process and implementing an electronic endoscopy order set were associated with a significant improvement in time to EGD and same-day cancellation rates. Next steps are to further decrease cancellation rates by developing standardized risk stratification process and to improve workflow by better utilization of procedure block time and efficient room turnover.

Upper Endoscopy Wait Times - Key Drive Diagram
Figure 1.pdfKey Driver Diagram

Upper Endoscopy Scheduling Work-Flow
Figure 2.pdfScheduling Work-Flow

XMR and SPC charts for Average EGD wait times (3a) and Same day cancellations (3b)
Figure 3a and b.pdfAverage EGD wait times and Same Day Procedure cancellations