The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Ziad F Gellad - One of the best experts on this subject based on the ideXlab platform.
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bolus administration of fentanyl and midazolam for colonoscopy increases Endoscopy Unit efficiency and safety compared with titrated sedation
Clinical Gastroenterology and Hepatology, 2017Co-Authors: Thomas R Finn, Ziad F Gellad, Amanda Boyd, Li LinAbstract:Background & Aims Guidelines recommend slow titration of sedatives for moderate sedation. Bolus sedation, in which a larger weight-based dose of medication is given upfront, has been shown in a single trial to be beneficial. We evaluated the effects of bolus sedation on procedural safety, efficiency, and patient experience. Methods We performed a retrospective analysis of colonoscopies performed between April 2010 and April 2011 at Duke Medical Center. Colonoscopies before October 2010 were performed with nurse-directed titration of sedative (n = 966); colonoscopies performed after October 2010 were performed with physician-directed administration of bolus sedative (n = 699). We compared sedation and recovery times, medication doses, and adverse events between groups. We also compared patient satisfaction in a subset of patients from each group. Data were compared using the chi-square test for categorical variables and Wilcoxon rank sum test for continuous and ordinal categorical variables. Results Patients in the bolus group had a shorter sedation time (6.0 min) than patients in the titration group (13.0 min; P Conclusions In a retrospective study of patients undergoing colonoscopy, we found that compared with titrated administration of sedative, bolus dosing improves Endoscopy Unit efficiency and safety and decreases the amount of sedative required. This benefit does not come at the expense of the patient experience.
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sa1491 automating Endoscopy Unit efficiency metrics leveraging the electronic health record for process improvement
Gastrointestinal Endoscopy, 2015Co-Authors: Ziad F Gellad, David Chermak, Emmanuel Brown, Javad TaheriAbstract:Kaplan-Meier Curve: Requirement of further therapy in IBD and non-IBD patients. Sa1491 Automating Endoscopy Unit Efficiency Metrics: Leveraging the Electronic Health Record for Process Improvement Ziad Gellad*, David Chermak, Emmanuel Brown, Javad Taheri Duke University Medical Center, Durham, NC; Durham VA Medical Center, Durham, NC; Industrial and Systems Engineering, North Carolina State University, Raleigh, NC Purpose: Improving efficiency in GI Endoscopy is both a business mandate and a quality imperative. Meaningful Endoscopy Unit efficiency metrics have been published but access to reliable time data impedes use of these measures. Methods: We developed a custom query of our electronic health record (Epic, Verona, WI) to obtain time tracking data for gastrointestinal Endoscopy procedures occurring in our hospital based Endoscopy Unit and smaller ambulatory surgical center. Physicians in these Units perform a broad array of diagnostic and therapeutic Endoscopy with a mix of anesthesia and non-anesthesia sedation. To obtain time stamps, we first mapped the flow of patients through the Endoscopy Unit as a series of discrete events from check-in to discharge. Secondly, through a process of observation and qualitative analysis, we identified specific nursing and physician activities within the electronic health record that corresponded to the beginning and end of each discrete event. Thirdly, we identified specific data elements in the electronic record that indicated time parameters for these events. Fourth, we queried the electronic record data tables to build a custom dataset of time stamps for each completed patient encounter. Required time stamps were available in over 95% of encounters; missing time stamps were excluded from calculations. Finally, we calculated a set of efficiency metrics from this dataset that included: Procedure Volume, Room Utilization, Overtime, On-Time Start, Room Turnover Time, and Patient Waiting Time. Results: Between July 1, 2013 and June 30, 2014, we collected time stamp data on 3,741 cases in the ambulatory surgical site and 5,743 cases in the hospital based Unit. Efficiency metrics, averaged monthly over the time period of collection, are outlined in the table. The ambulatory site was more efficient than the hospital based Unit across all metrics. Conclusions: Through careful process mapping and workflow standardization, the electronic health record can be leveraged to collect time data for Endoscopy Unit efficiency metrics. Collection of these metrics can be used to benchmark against other practices and help guide process improvement activities. Average monthly Endoscopy Unit efficiency metrics (mean, sd)
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Endoscopy Unit efficiency quality redefined
Clinical Gastroenterology and Hepatology, 2013Co-Authors: Ziad F Gellad, Cole P Thompson, Javad TaheriAbstract:This month’s contribution by Gellad et al concerns efficiency within an Endoscopy Unit. There are over 5400 Medicare certified ambulatory surgical centers (ASC) in the United States providing a distributed network of high quality, accessible centers for patients in need of outpatient endoscopic procedures. Most of these Units are running efficiently with little room for waste (or they would not be able to survive in the current environment). Dr Gellad and colleagues have developed a process to analyze effi ciency by defining performance metrics based on standard Dona bedian analysis. Their article relates mostly to Units performing a mix of procedures usually within a hospital Unit. These Units, unlike ASCs, deserve our scrutiny since many are operated at efficiency levels that provide “opportUnities.”
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a simulation study to reduce nurse overtime and improve patient flow time at a hospital Endoscopy Unit
Winter Simulation Conference, 2012Co-Authors: Javad Taheri, Ziad F Gellad, Dariele Burchfield, Kevin D CooperAbstract:Increasing demand for endoscopic procedures, coupled with decreasing insurance reimbursement, has necessitated improvement in Endoscopy Unit operational performance measures, such as increasing throughput and reducing staff overtime without an increase in patient waiting time. In pursuit of improving these measurements, maintaining the nurse-to-patient ratio requirements in the recovery area throughout the clinic's operation time is a challenging problem for Endoscopy Units. To maintain compliance with this ratio, patients occasionally have to be held in the procedure rooms during the clinic's peak time. On the other hand, level loading could potentially increase the amount of overtime. In this paper, we describe our efforts to use discrete event simulation to investigate the impact of several strategies to address the minimum recovery nurse requirements in the Endoscopy Unit of Duke University Medical Center. Our objective was to minimize patient flow times and nurse overtime while sustaining the required nurse-patient staffing ratio in recovery.
Javad Taheri - One of the best experts on this subject based on the ideXlab platform.
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sa1491 automating Endoscopy Unit efficiency metrics leveraging the electronic health record for process improvement
Gastrointestinal Endoscopy, 2015Co-Authors: Ziad F Gellad, David Chermak, Emmanuel Brown, Javad TaheriAbstract:Kaplan-Meier Curve: Requirement of further therapy in IBD and non-IBD patients. Sa1491 Automating Endoscopy Unit Efficiency Metrics: Leveraging the Electronic Health Record for Process Improvement Ziad Gellad*, David Chermak, Emmanuel Brown, Javad Taheri Duke University Medical Center, Durham, NC; Durham VA Medical Center, Durham, NC; Industrial and Systems Engineering, North Carolina State University, Raleigh, NC Purpose: Improving efficiency in GI Endoscopy is both a business mandate and a quality imperative. Meaningful Endoscopy Unit efficiency metrics have been published but access to reliable time data impedes use of these measures. Methods: We developed a custom query of our electronic health record (Epic, Verona, WI) to obtain time tracking data for gastrointestinal Endoscopy procedures occurring in our hospital based Endoscopy Unit and smaller ambulatory surgical center. Physicians in these Units perform a broad array of diagnostic and therapeutic Endoscopy with a mix of anesthesia and non-anesthesia sedation. To obtain time stamps, we first mapped the flow of patients through the Endoscopy Unit as a series of discrete events from check-in to discharge. Secondly, through a process of observation and qualitative analysis, we identified specific nursing and physician activities within the electronic health record that corresponded to the beginning and end of each discrete event. Thirdly, we identified specific data elements in the electronic record that indicated time parameters for these events. Fourth, we queried the electronic record data tables to build a custom dataset of time stamps for each completed patient encounter. Required time stamps were available in over 95% of encounters; missing time stamps were excluded from calculations. Finally, we calculated a set of efficiency metrics from this dataset that included: Procedure Volume, Room Utilization, Overtime, On-Time Start, Room Turnover Time, and Patient Waiting Time. Results: Between July 1, 2013 and June 30, 2014, we collected time stamp data on 3,741 cases in the ambulatory surgical site and 5,743 cases in the hospital based Unit. Efficiency metrics, averaged monthly over the time period of collection, are outlined in the table. The ambulatory site was more efficient than the hospital based Unit across all metrics. Conclusions: Through careful process mapping and workflow standardization, the electronic health record can be leveraged to collect time data for Endoscopy Unit efficiency metrics. Collection of these metrics can be used to benchmark against other practices and help guide process improvement activities. Average monthly Endoscopy Unit efficiency metrics (mean, sd)
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Endoscopy Unit efficiency quality redefined
Clinical Gastroenterology and Hepatology, 2013Co-Authors: Ziad F Gellad, Cole P Thompson, Javad TaheriAbstract:This month’s contribution by Gellad et al concerns efficiency within an Endoscopy Unit. There are over 5400 Medicare certified ambulatory surgical centers (ASC) in the United States providing a distributed network of high quality, accessible centers for patients in need of outpatient endoscopic procedures. Most of these Units are running efficiently with little room for waste (or they would not be able to survive in the current environment). Dr Gellad and colleagues have developed a process to analyze effi ciency by defining performance metrics based on standard Dona bedian analysis. Their article relates mostly to Units performing a mix of procedures usually within a hospital Unit. These Units, unlike ASCs, deserve our scrutiny since many are operated at efficiency levels that provide “opportUnities.”
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a simulation study to reduce nurse overtime and improve patient flow time at a hospital Endoscopy Unit
Winter Simulation Conference, 2012Co-Authors: Javad Taheri, Ziad F Gellad, Dariele Burchfield, Kevin D CooperAbstract:Increasing demand for endoscopic procedures, coupled with decreasing insurance reimbursement, has necessitated improvement in Endoscopy Unit operational performance measures, such as increasing throughput and reducing staff overtime without an increase in patient waiting time. In pursuit of improving these measurements, maintaining the nurse-to-patient ratio requirements in the recovery area throughout the clinic's operation time is a challenging problem for Endoscopy Units. To maintain compliance with this ratio, patients occasionally have to be held in the procedure rooms during the clinic's peak time. On the other hand, level loading could potentially increase the amount of overtime. In this paper, we describe our efforts to use discrete event simulation to investigate the impact of several strategies to address the minimum recovery nurse requirements in the Endoscopy Unit of Duke University Medical Center. Our objective was to minimize patient flow times and nurse overtime while sustaining the required nurse-patient staffing ratio in recovery.
Chris E Forsmark - One of the best experts on this subject based on the ideXlab platform.
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impact of endotracheal intubation on interventional Endoscopy Unit efficiency metrics at a tertiary academic medical center
The American Journal of Gastroenterology, 2016Co-Authors: Yaseen B Perbtani, Robert J Summerlee, Dennis Yang, Alejandro L Suarez, Blair J Williamson, Charles W Shrode, Anand Gupte, Shailendra S Chauhan, Peter V Draganov, Chris E ForsmarkAbstract:Impact of Endotracheal Intubation on Interventional Endoscopy Unit Efficiency Metrics at a Tertiary Academic Medical Center
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evaluation of interventional Endoscopy Unit efficiency metrics at a tertiary academic medical center
Endoscopy International Open, 2015Co-Authors: Dennis Yang, Yaseen B Perbtani, Robert J Summerlee, Alejandro L Suarez, Blair J Williamson, Charles W Shrode, Anand Gupte, Shailendra S Chauhan, Peter V Draganov, Chris E ForsmarkAbstract:Background and study aims: There is an increasing demand for interventional endoscopic services and the need to develop efficient endoscopic Units. The aim of this study was to analyze performance data and define metrics to improve efficiency in a single academic interventional Endoscopy center. ]Patients and methods: The prospective operations performance data (6-month period) of our interventional Endoscopy Unit (EU) was analyzed. First-case start time (FIRST) delay was defined as any time the first patient of the day entered the Endoscopy room after the scheduled time. Non-Endoscopy time (NET) and total time (TT) were defined as non-procedural and total time elapsed in the EU, respectively. Time-interval between successive patients (TISP) was defined as the time from one patient departure from the room until the time of arrival of the next patient in the room. Results: A total of 1421 patients underwent 1635 endoscopic procedures. FIRST was delayed (54.2 % cases) by 13.6 min (range 1 – 53), but started within 15 min of the scheduled time in 85 % of the cases. NET accounted for 9.1 hours (67.2 %) of 13.5 hours TT/day. TISP (37.1 min, range 5 – 125) comprised 54.2 % of the NET, and was delayed (> 30 min) in 49.8 % of cases. “Patient flow” processes (registration, admission, transportation, scheduling) accounted for 50.1 % of TISP delays. Conclusions: Delays in NET, specifically TISP, rather than FIRST, were identified as a cause for decreased efficiency. “Patient flow” processes were the main reasons for delays in TISP. This study identifies potential process measures that can be used as benchmarks to improve efficiency in the EU.
Kara L. Raphael - One of the best experts on this subject based on the ideXlab platform.
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Remote video auditing in the Endoscopy Unit for evaluation of duodenoscope reprocessing in a tertiary care center.
Endoscopy, 2020Co-Authors: Kara L. Raphael, Ellen Mcnoble, Jessica Goldbeck, Megan Stiles, Larry S. Miller, Arvind J. TrindadeAbstract:BACKGROUND : A significant proportion of duodenoscope-transmitted infections have resulted from errors related to reprocessing. Remote video auditing (RVA) is a tool that can monitor reprocessing compliance but it has not been previously evaluated in a tertiary care setting. The aims of this study were to evaluate: 1) RVA feasibility in a tertiary care setting (defined as the ability to audit every step of duodenoscope reprocessing without delaying the next procedure due to unavailability of duodenoscopes); and 2) the use of RVA as a compliance monitoring tool. METHODS : This was a prospective study at a tertiary care center. A video camera with offsite monitoring was installed in March 2018. Auditors delivered a compliance score after each procedure. The duodenoscope was not used until it passed the audit. Feasibility and compliance data were collected from April 2018 to August 2019 after a 1-month run-in phase. Both per-step compliance and overall 100 % compliance rates were measured. RESULTS : Of 743 duodenoscope reprocessing procedures, 32 666 individual steps were audited and 99.9 % of the steps were fully viewable. The mean time per audit was 38.3 minutes, the mean duodenoscope turnover time was 76.1 minutes, and there were no delays to the next procedure due to unavailability of duodenoscopes. The per-step compliance rate was 99.5 % but the overall 100 % compliance rate was 90.3 %. CONCLUSIONS : The use of RVA in duodenoscope reprocessing was feasible and promoted sustained high-level compliance in a tertiary care center.
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Improving patient safety in the Endoscopy Unit: utilization of remote video auditing to improve time-out compliance
Gastrointestinal endoscopy, 2019Co-Authors: Kara L. Raphael, Sara Cerrone, Edward Sceppa, Patricia Schneider, Tara Laumenede, Ann Lynch, Divyesh V. SejpalAbstract:Background and Aims Patient and procedure verification, or the time-out process (TOP), is considered one of the most vital components of patient safety. It has long been a focus of intervention in the surgical commUnity and recently was incorporated into the American Society for Gastrointestinal Endoscopy guidelines for safety in the GI Endoscopy Unit. The TOP has had limited attention in the Endoscopy literature but remains an area for improvement in clinical Endoscopy practice. The aim of this study was to identify barriers and improve TOP compliance rates in our Endoscopy Unit using remote video auditing (RVA). Methods This was a single-center, prospective, pilot initiative in an Endoscopy Unit at a tertiary care academic medical center. Video cameras with offsite monitoring were installed in each procedure room in our Endoscopy suite in November 2016. Baseline TOP compliance rates were audited with RVA over a 2-month period. A multidisciplinary quality improvement team reviewed the data, identified barriers to the TOP, and implemented actionable items in January 2017. TOP compliance rates were again monitored via RVA, and data were collected through October 2018. Pre- and postintervention TOP compliance rates were compared. Results Over the baseline period, 692 procedures were audited and TOP compliance documented. Baseline TOP compliance rate was 69.6%. Identifiable barriers to TOP compliance included a lack of designated team member to lead TOP, inconsistent documentation of TOP, irrelevant safety checklist items not applicable to endoscopic procedures, and lack of patient safety culture. Actionable items implemented in response to these barriers included designation of a TOP leader, visual indication of initiation of TOP, creation of a concise Endoscopy-specific safety checklist, and formal notification/education of the entire Endoscopy team. Postintervention TOP compliance rates were then audited from January 2017 to October 2018 and included 12,008 procedures. The mean TOP compliance rate significantly improved from baseline (95.3% vs 69.6%; 95% confidence interval, 22.4-29.3; P Conclusions TOP compliance rates significantly improved in our Endoscopy Unit through the use of RVA and implementation of 4 actionable items. Future studies should evaluate the reproducibility of this method in other Endoscopy Units.
Yaseen B Perbtani - One of the best experts on this subject based on the ideXlab platform.
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impact of endotracheal intubation on interventional Endoscopy Unit efficiency metrics at a tertiary academic medical center
The American Journal of Gastroenterology, 2016Co-Authors: Yaseen B Perbtani, Robert J Summerlee, Dennis Yang, Alejandro L Suarez, Blair J Williamson, Charles W Shrode, Anand Gupte, Shailendra S Chauhan, Peter V Draganov, Chris E ForsmarkAbstract:Impact of Endotracheal Intubation on Interventional Endoscopy Unit Efficiency Metrics at a Tertiary Academic Medical Center
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evaluation of interventional Endoscopy Unit efficiency metrics at a tertiary academic medical center
Endoscopy International Open, 2015Co-Authors: Dennis Yang, Yaseen B Perbtani, Robert J Summerlee, Alejandro L Suarez, Blair J Williamson, Charles W Shrode, Anand Gupte, Shailendra S Chauhan, Peter V Draganov, Chris E ForsmarkAbstract:Background and study aims: There is an increasing demand for interventional endoscopic services and the need to develop efficient endoscopic Units. The aim of this study was to analyze performance data and define metrics to improve efficiency in a single academic interventional Endoscopy center. ]Patients and methods: The prospective operations performance data (6-month period) of our interventional Endoscopy Unit (EU) was analyzed. First-case start time (FIRST) delay was defined as any time the first patient of the day entered the Endoscopy room after the scheduled time. Non-Endoscopy time (NET) and total time (TT) were defined as non-procedural and total time elapsed in the EU, respectively. Time-interval between successive patients (TISP) was defined as the time from one patient departure from the room until the time of arrival of the next patient in the room. Results: A total of 1421 patients underwent 1635 endoscopic procedures. FIRST was delayed (54.2 % cases) by 13.6 min (range 1 – 53), but started within 15 min of the scheduled time in 85 % of the cases. NET accounted for 9.1 hours (67.2 %) of 13.5 hours TT/day. TISP (37.1 min, range 5 – 125) comprised 54.2 % of the NET, and was delayed (> 30 min) in 49.8 % of cases. “Patient flow” processes (registration, admission, transportation, scheduling) accounted for 50.1 % of TISP delays. Conclusions: Delays in NET, specifically TISP, rather than FIRST, were identified as a cause for decreased efficiency. “Patient flow” processes were the main reasons for delays in TISP. This study identifies potential process measures that can be used as benchmarks to improve efficiency in the EU.