Archive Surgical Construction 2018

How to Outfit for GI

5 design and equipment tips for efficient endo suites.

Bunny Twiford, RN

BIO

Smart Scheduling
SMART SCHEDULING Will this upper GI scope be free to use for the next scheduled case? That depends largely on how you staggered your procedures.

You can tell a lot about an endoscopy center by looking in an unlikely place: the waiting room. If you spot patients wearing ID bands sitting in the waiting room after the first few cases of the day, you can be pretty sure that all the scopes and stretchers are in use, and that the sole automated endoscope reprocessor is occupied, as is the only restroom. Yep, another case of GI gridlock caused by poor facility design and not enough equipment.

For each of the 40 or so GI rooms I helped design and equip, and guide through certification and accreditation, I kept the same goal in mind: Patients should be in and out of the facility in about 90 minutes. Here are 5 tips to keep the patients flowing — instead of making a U-turn at the registration desk and backing up into the waiting room.

1. Have enough restrooms. Anyone who's had a bowel prep knows the importance of a restroom. No pun intended, but not having enough restrooms can clog your schedule. I'd suggest at least 1 for the waiting area and at least 2 in the admitting area. Remember, patients might still be eliminating from the prep when they arrive for check-in. While we're on the subject, instruct your admit nurses to screen patients by asking if they're cleared out — and don't take the patients' word for it. If a patient has to use the restroom during the admitting process, tell him not to flush so the nurse can see for herself if it's clear. Let the doctor know if there are formed particles. You don't want to wheel a patient into a procedure room and open supplies only to find out that the doctor can't do the case because the patient is not adequately prepped.

2. Buy enough scopes. At about $30,000 apiece, GI scopes will be your biggest equipment expense. How many will you need? I've never bought less than 10 scopes (7 colonoscopes and 3 uppers) to start a center. Case mix is extremely important if you have a limited number of scopes. Ask each of your docs how many slots he can realistically fill in a day or a half day (they tend to overpromise). Let's assume a 70:30 colonoscopy-to-upper endoscopy ratio. If we allow 15 minutes for an EGD, 30 minutes for a colonoscopy and 45 for a double procedure — and about 45 minutes for reprocessing, which involves leak testing, manual cleaning and reprocessing through the AER — you likely won't run out of scopes:

  • if you schedule a colonoscopy every half hour and an endoscopy every 15 or 20 minutes, and
  • if you stagger the schedule accordingly — first an EGD, then 2 colonoscopies, then an EGD.
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