Post written by Zoë Post, MD, MSc, and Neal A. Mehta, MD, from Rush University Medical Center, Chicago, Illinois, USA.

The main purpose of our study was to improve turnover time in the endoscopy unit.

We first defined the various components of the turnover process and identified the teams that are involved, such as anesthesiologists, nurses, technicians, and gastroenterologists. We then assessed time spent by these teams in the various components to determine areas that could benefit from optimization.

We have noticed a backlog of endoscopy cases after the COVID-19 pandemic and with the increased size of the screening colonoscopy population now that the guidelines are recommending starting screening at age 45. We were therefore interested in improving the efficiency in our endoscopy unit in order to increase case load, without affecting duration and quality of endoscopic examinations.

One of our observations was that some teams were waiting for other teams to complete their tasks during the turnover process, which inspired us to look into this further. As we started assessing the turnover process, we discovered that it has different definitions and components depending on which team is asked. We felt it was important to emphasize that teams view the turnover process differently, and this understanding is vital to not only identify components that benefit from optimization, but also to foster clear communication between teams, as lack of understanding can lead to frustrations in the work environment.

In our study, we first provided clear definitions of components of the turnover process and how the various teams are involved. Next, we found that in our endoscopy unit specifically, the process of patient transport could be optimized by our gastroenterology nurses instead of the certified registered nurse anesthetist transporting the patient to the procedure room. This simple change can increase our outpatient diagnostic endoscopy case load by 10%, without affecting procedure time.

Furthermore, this intervention can result in an annual revenue potential of more than $3 million. We therefore show that using our defined turnover process to identify areas needing improvement can enhance efficiency in the endoscopy unit, increase case load, and result in financial gain.

The 7 key components of the turnover process. Gastroenterologist perceived turnover time (TOT) includes wait time/wrap-up time after the procedure ends, postanesthesia care unit (PACU) transport and PACU handoff, preprocedure assessment by anesthesia team, transport from preprocedure area to the procedure room, in-room set up, and the time out. Anesthesia perceived TOT includes the preprocedural evaluation of the next patient and transporting the patient to the procedure room. Standard TOT includes PACU transport and PACU handoff, preprocedure assessment by anesthesia team, and transport from preprocedure area to the procedure room. OR, Operating room; PR, procedure room; CRNA, certified registered nurse anesthetist; Pre-Op, preoperative; Postop, postoperative.

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