orm_asc_october-2024 - 4

Leadership
Preventing missed appointments
Strategies to prevent missed endoscopy
appointments include:
➤ Sending texts and emails to confirm.
➤ Making phone calls. Hess notes that calling
patients ahead of time helps reduce
cancelled cases by enabling staff to verify
that patients have had a history and physical
completed, and that they understand
which medications to stop taking.
➤ Offering transportation resources. Santy
says her center provides a list of medical
a timely manner, " she says.
At Saint Francis, block scheduling
is done mostly based on the individual
physician, but also by group, Santy
says. There is a 5-day release period
for the blocks. Emergent inpatients and
emergency department patients are
treated as add-ons and escalated as
needed.
Missed appointments also affect
productivity. Tewani believes no-shows
are more common when patients are
booked out longer than 2 or 3 weeks.
This is borne out by a study by Yilmaz
and Kocyigit that identified longer lead
times as a factor associated with
missed appointments. Other factors
included gender, screening (as opposed
to diagnostic procedures), and absence
of planned deep sedation. A study by
Hookey and colleagues found no significance
difference in gender or type
of procedure when it came to missed
appointments, but younger patients and
those with more previous visits had a
higher proportion of missed appointments
and cancellations.
Santy says a common reason for noshows
is an issue with transportation
for patients who will be receiving anesthesia.
Patients also cancel because
they could not tolerate the prep, whether
because they do not understand it (sidebar,
Preventing missed appointments) or
for medical reasons. " Patients may not
physically be able to complete the prep
4
ASC Leader | October 2024
cabs and medical vans.
➤ Providing detailed patient education. Hess
says her center developed a patient information
sheet for offices to give to patients.
➤ Overbooking. This can be helpful even without
using a complicated model. Hookey
and colleagues found that using a predictive
model for overbooking was no better
than straight overbooking for addressing the
problem. Straight overbooking was calculated
by missed appointment percentage.
because they are sick in other ways, "
Santy says. Those with diabetes or cardiac
or kidney disease are especially
prone to this problem.
Staffing
The article by Tewani and colleagues
recommends 0.5 to 0.75 full-time equivalent
endoscopic technician (ET) per
procedure room for ASCs. At his center,
ETs' primary responsibilities include
cleaning, reprocessing, and maintaining
endoscopes and accessories as well
as assisting with room turnover. In the
hospital setting, ETs may be involved
in such complex procedures as endoscopic
ultrasound and ERCP.
Dr Tewani's practice uses one RN
per procedure room in the ASC setting.
In the hospital setting, the practice
uses either two RNs or one RN and
one ET per room. He notes that leaders
need to follow state regulations related
to staffing. Hess staffs the GI endoscopy
room with two RNs and a GI technician.
RNs working in other areas of
the ASC are also trained to work in the
GI room.
The 45-member staff at Saint Francis
consists of RNs, licensed practical
nurse, a surgical technologist, and certified
nursing assistants (CNAs), some of
whom who are ETs or members of the
high-level disinfection (HLD) team. Staff
take call for emergent cases one weekend
day every 6 weeks, one holiday a
year, and up to 6 weeknights per each
6-week schedule. Despite call, which
Santy says is a dissatisfier for staff,
she has built up a stable staff over the
past 2 years and currently has no open
positions. " I think the reason is a combination
of education, listening to each
other, being accountable, and making
it a profession versus a job, " she says.
In addition to conducting monthly
staff meetings, Santy meets frequently
with individual staff members. Monthly
" Coffee and Conversation " education
programs also help foster staff development.
All the RNs belong to the Connecticut
chapter of the Society of Gastroenterology
Nurses and Associates
(SGNA), and over half of full-time nurses
have earned Certified Gastroenterology
Registered Nurse credentials through
the American Board of Certification for
Gastroenterology Nurses (ABCGN). In
March, ABCGN recognized the facility
for this achievement, and in April, the
facility received the SGNA Flame Award
for Unit Excellence, which recognizes
GI/endoscopy units that " have shown
a commitment to infection prevention, a
supportive and educational work environment
and positive patient outcomes. "
Dr Tewani's practice includes nine
NPs who function in the outpatient center
and the hospital. " In the outpatient
setting, they are independent providers
who manage patients on their own, " he
says. In addition to managing patients'
conditions, NPs conduct preprocedure
evaluations and are responsible for
postprocedure care, which frees physicians
to focus on endoscopies. Physicians
and NPs team up for patients with
complex conditions such as cirrhosis.
The choice of sedation also affects
staffing. For moderate (conscious) sedation,
the necessary administration qualifications
depend on state regulations.
At Hess's ASC, annual online training is
sufficient for those who work with moderate
sedation. However, the monitored
anesthesia care (MAC) used by two of
the center's three surgeons presents
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