ASGE Endoscopy Unit Recognition Program (EURP) submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The QI project in the spotlight this month looks at reducing the number of canceled cases.
PROJECT
Patient wait times and the patient’s perception of wait times regarding patient satisfaction.
DEFINE
It is suspected that patients are perceiving excessive wait times in relation to their experience at [the facility] and delays in discharge which is increasing the time the patient is in the facility.
The target for performance for patient wait time scores was 4.6 or higher (patient satisfaction surveys) and the patient’s average time in the facility of 150 minutes or less.
MEASURE
The performance measure of interest was patient wait times and average time in the facility.
The baseline data for patient wait times for all of 2020 was acquired from our patient satisfaction surveys from 1,829 patients.
The baseline performance measurement before intervention was an overall wait time score of 4.49 in 2020 and 168.7 minutes in 2020 for average time in the facility.
ANALYZE
Some of the higher-level factors that contributed to the variance were the average patient was in the facility from arrival to actual discharge including the length of time it took the physician to discharge the patient once the patient was ready. The average patient was in the facility 168.7 minutes. This varied by physician with time averages ranging from 158.1-172.9 minutes.
The tools utilized to monitor patient wait times were the review of Patient Satisfaction results for 1,829 patients seen at the facility in 2020. This was the number of patient surveys returned in 2020 out of 3,713 total patients. We also reviewed patient satisfaction results for wait times of 952 patients seen in the facility from January to June for 2021.
We also did a retrospective review of 20 charts quarterly in 2020 and the first two quarters of 2021 for review of average times the patient was in the facility from admission to discharge. A total of 80 charts were reviewed in 2020 and 40 charts were reviewed in 2021 for the average time the patient was in the facility from admission to discharge.
IMPROVE
The project addressed the development of a wait time initiative and education of staff to assure the nurse was monitoring time a patient might be waiting for admission and discharge. If the patient had been waiting for 20 minutes, the nurse was to give the patient a status report. If the patient had been waiting for 30 minutes, the plan for discharge would be discussed with he physician. Typically, this was related to an extended procedure.
The interventions we implemented were defining expectations of what is a start time (i.e., if a physician has a start time of 7:45 am, the patient is in the procedure room and the procedure starts at 7:45 am).
We also educated staff on what to do if the patient has waited 20 minutes or more for admission or for the physician to discharge them and the importance of keeping the patient informed of any delays.
The repeat measurement of performance was a wait time score of 4.55 in June of 2021 and the average time in the facility for January to June 2021 was 145.2 minutes.
CONTROL
While there was an improvement of .6 in the unit’s total patient wait time score of 2021 to 4.55, we did not meet the patient satisfaction goal of 4.6. There was an improvement in the average time in the facility to 145.2 minutes, thus meeting the goal of an average time in the facility of 150 minutes or less.
The results were shared with the physicians and the staff. We will remeasure both measures in June 2022 and re-educate staff and physicians as needed.
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.