A Multimodal Interdisciplinary QI Intervention Is Associated With Reduction in After Hours Inpatient Endoscopy Cases

BACKGROUND AND AIMS: Increasing demand for inpatient endoscopic services results in performing more non-emergent endoscopic cases after-hours, which poses risks to patient safety and negatively impacts patient and provider satisfaction. This study sought to quantify the existing state using quality improvement methodology, design targeted interventions, and determine their effectiveness. METHODS: We conducted an existing state evaluation through a process map, time-series study, and caseload analysis from 7/2017 to 12/2018. Using end-of-workday (EOW) as a proxy for patient and/or provider dissatisfaction and risk for patient safety events, we performed a prospective evaluation of a staged interdisciplinary multimodal intervention aimed to decrease the proportion of days with EOW after 7 PM, decrease the proportion of cases begun after 5 PM, and decrease EOW variability. The postintervention period was 6/2019-2/2020.S RESULTS: Based on existing state analyses, we implemented a series of targeted interventions: (1) provider workflow tips, (2) expedited transport for select patients, (3) pathway to reschedule appropriate cases to outpatient endoscopy, and (4) increased staffing for high caseload days through resource pooling. The proportion of days with EOW after 7 PM decreased from 42.4% to 29.3% (caseloadadjusted odds ratio of 0.39, P < 0.001). Despite increased caseload, cases begun after 5PM decreased from 17.5% to 14.2% (OR 0.75, P = 0.009). EOW SD decreased from 2:20 hours to 1:36 hours. CONCLUSION: The multimodal intervention reduced days with EOW after 7PM and the proportion of cases begun after 5PM, despite increased caseload. This study shows how applying research methods to implement QI interventions successfully decreases late inpatient endoscopic cases.