Changing Anesthesia Block Allocations Improves Endoscopy Suite Efficiency.

Non-operating room anesthesia (NORA) has grown and continues to expand as a proportion of all anesthesia practice in the United States [1, 2]. While many management processes have been adapted for NORA from the traditional operating room, it is still unclear what scheduling paradigm will maximize efficiency of resource utilization in this arena. In this study, we investigate the impact of tactical a shift from a shared group to individual, provider-specific block allocations for available anesthesia time in an endoscopy suite for adult patients undergoing elective endoscopy procedures at an academic hospital. Using a retrospective and prospective analysis, we measured elective time-in-block; elective time out-of-block; under-utilized (opportunity and non-opportunity unused) time; over-utilized time; and case tardiness to determine operational efficiency and clinical productivity. Over the study period, the monthly caseload remained constant. Elective time in block increased by 156% (p \u3c 0.0001) and elective time out of block decreased by 38% (p \u3c 0.0001). Opportunity unused time decreased by 28% (p \u3c 0.0001) and productivity increased by 51% (p \u3c 0.0001). Neither over-utilized time nor case tardiness showed a significant change after the intervention. Despite the evidence base supporting traditional approaches to anesthesia block allocation involving group block allocation and non-sequential case scheduling, we have demonstrated an advantage to individual block allocation in a GI endoscopy setting. This sequential case scheduling highlights how tactical decisions in NORA environments may require a rethinking of many practices that anesthesiologists have brought with them from the traditional OR. Using these efficiency and productivity metrics, further adjustments to scheduling practices should be investigated, and connecting these metrics to other systems outcomes, such as financial productivity, is an important next step as NORA services expand into the future

Promoting Use of Colorectal Cancer Screening Tests: Can We Change Physician Behavior?

BACKGROUND: Colorectal cancer (CRC) screening is underutilized despite evidence that screening reduces mortality. OBJECTIVE: To assess the effect of an intervention targeting physicians and their patients on rates of CRC screening. DESIGN: A randomized clinical trial of community physicians and their patients. PARTICIPANTS: Ninety-four community primary care physicians randomly assigned to an intervention consisting of academic detailing and direct mailings to patients or a control group. Patients aged 50 to 79 years in the intervention group physicians received a letter from their physician, a brochure on CRC screening, and a packet of fecal occult blood test (FOBT) cards. MEASUREMENTS: After 1 year we measured receipt of the following: (1) FOBT in the past 2 years, (2) flexible sigmoidoscopy (SIG) or colonoscopy (COL) in the previous 5 years, and (3) any CRC screening. We report the percent change from baseline in both groups. RESULTS: 9,652 patients were enrolled for 2 years, and 3,732 patients were enrolled for 5 years. There was no increase in any CRC screening that occurred in the intervention group for patients enrolled for 2 years (12.7 increase vs 12.5%, P=.51). Similar results were seen for any CRC screening among patients enrolled for 5 years (9.7% increase vs 8.6%, P=.45). The only outcome on which the intervention had an effect was on patient rates of screening SIG (7.4% increase vs 4.4%, P<.01). CONCLUSION: With the exception of an increase in rates of SIG in the intervention group, the intervention had no effect on rates of CRC screening. Future interventions should assess innovative approaches to increase rates of CRC screening