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Health Services Research & Development

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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3098 — Using Discrete Event Simulation to Design an Endoscopy Suite Configuration

Taheri J (Durham VA Medical Center), Gellad Z (Durham VA Medical Center), Haque M (Durham VA Medical Center)

The gastrointestinal endoscopy units at the VA medical centers have been challenged with the rising demand for Colorectal Cancer (CRC) screening. Our aim for this study was to develop a simulation model of the current state of the endoscopy suite to be used as tool for developing a phase-by-phase resource plan to staff a larger and modernized unit as well as identifying areas of efficiency improvements in the current suite.

We developed a Discrete Event Simulation (DES) model of the current state of the three room endoscopy unit. The data for the model was captured by suite staff using a patient de-identified data collection sheet over 10 consecutive days. Input analysis was performed to fit probability distributions to collected data. Alternative models were then developed, incorporating phase-by-phase demand and capacity increases. A series of “what if” analyses were performed to compare the performance measures of the baseline model with the results from the alternative scenarios. The key outcome measures were: average number of daily procedures, including endoscopy and colonoscopy; average resource utilization, including physicians, pre-procedure nurses, technicians, recovery nurses, and procedure rooms; patient waiting time at each stage of the process (i.e., preparation, procedure, and recovery); clinic overtime; and patient flow time from arrival to discharge.

The model showed that staffing an additional procedure room and increasing the number of preparation and recovery rooms from 5 to 9 would increase the overall capacity of the clinic by 40%. The model also identified an opportunity to increase the overall clinic capacity by an additional 10% if a staggered nurse schedule were to be implemented.

DES simulation modeling and analysis is an effective and powerful tool for studying the capacity and operational efficiency of endoscopy clinics within VA medical centers, which in turn have direct impact in improving patient access and reducing the cost of providing service.

The proposed staffing plan was approved by the medical center leadership and is being implemented. In near future, the simulation models will be used in a post implementation study to evaluate the impact of the implementation of the staffing plan and the recommended nurse scheduling method.

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