Successful applicants to the ASGE Endoscopy Unit Recognition Program submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The quality assurance and performance improvement (QAPI) project in the spotlight this month looked at cancellations and no-shows.

Situation/Background

The endoscopy department has been seeing a high percentage of cancellations/no-shows over the past few years. One factor that the GI and endoscopy department lacked was a registered nurse (RN) to prep patients, answer questions and confirm appointments. Previously and currently, our medical assistants prep patients while scheduling appointments in addition to reaching out to primary care and specialty care providers regarding patient-specific instructions related to blood-thinning medications and diabetic medications. However, without the clinical knowledge of the nursing staff, there have been some gaps in care that have led to on-site cancellations, no-shows and noncompliance with bowel preparation instructions.

Measures

In October of 2023, the endoscopy department flexed an RN to use as a part-time preadmission testing (PAT) lab nurse working under the GI clinic umbrella. This RN's duties included:

• Called to confirm appointments a week in advance
• Returned calls related to preprocedure preparation instructions
• Confirmed and reaffirmed specific patient medication needs (temporary discontinuation, bridging and continuation)
• Helped facilitate patient compliance and understanding regarding transportation to and from the procedure, as well as postanesthesia/sedation instructions
• Utilized direct communications with endoscopy nursing staff and leadership about special needs and patient circumstances to bridge the gap in patient care
• Communicated with endoscopy nursing staff, anesthesia providers and gastroenterologists about patient-specific sedation needs and considerations

Method

Daily tracking of cancellations was conducted for three pay periods prior to implementing a temporary trial PAT lab RN and three pay periods after implementation.

Results

• Cancellation rate measured from May 28, 2023, to June 25, 2023 = 9% (without PAT lab RN)
• Cancellation rate measured from August 20, 2023, to September 30, 2023 = 6.66% (with PAT lab RN)
• Percentage reduction of 2.34% in cancellations over the course of three pay periods with the PAT lab RN

Considerations

Factors that contributed to gaps in care that were often related to cancellations and/or no-shows were:

• Knowledge deficits
• Lack of education
• Staff communication
• Patient compliance
• Patient empowerment
• Staffing challenges
• Knowledge of correct clinical resources
• Phone system barriers
  

Outcome

The implementation of a dedicated PAT lab RN showed a 2.34% reduction in cancellations. Other positive outcomes included increased staff satisfaction in both the GI clinic and endoscopy, increased patient satisfaction, increased productivity and improvement in utilization of resources, including nursing staff, technician staff and anesthesia support services. The goal of this project was to reduce cancellations by 10%, which was surpassed by double. Since measuring outcomes of this project, the endoscopy department has continued to have a part-time PAT lab RN, and we are finding that many potential gaps in care and communication are being caught. Our future goal is to extend the endoscopy PAT lab RN program and add additional hours and/or job positions as such.

We hope sharing this project summary will be useful to you and your practice. Learn more about gaining honoree status in the ASGE Endoscopy Unit Recognition Program. EURP honoree units may use the ASGE Quality Star logo in promotion of their units, receive premium educational content bimonthly via an exclusive e-newsletter The Huddle, and enjoy a range of additional benefits. Questions should be directed to eurp@asge.org.