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Endoscopy
Figure 1: Michigan Endoscopy Center
each area within the facility spent approximately six months redesigning
work flow to maximize productivity within a fully electronic environment.
We have found that a paper process is in many ways different from an
electronic process. All MD and nursing activities are directly captured
within the reporting software; this results in increased chart
completeness and compliance, while allowing management to track each
time component of the patient experience. The information gathered is
regularly provided as feedback to the staff and physician users. For
example, a physician can access his/her colonoscopy withdrawal times
and compare them with the blinded peer group average.
Upfront patient documents, such as signed patient consents and recent
histories and physicals (H&Ps), are scanned and indexed into each patient’s
record. The same occurs with post-procedural documentation such as
pathology results. In this way, all components of the medical chart are
electronic—there are, quite simply, no hard copy files of medical records
within the facility. It is easy for patient information to be recalled by any
secured and approved user at any time, if necessary.
Staffing Design Administration and Local Management
Recruitment and retention of high-quality staff is critical for the delivery Given the complex nature of the center—16 physicians across
of an efficient patient experience. In-depth staff training is provided for seven different professional practices—a strong local manager is critical
new members of the team and, where possible, staff members are for successful day-to-day operations. The center therefore employs
cross-trained to enable them to perform work in multiple areas in the
facility. For instance, medical assistants rotate through the various
procedure rooms and the decontamination room on a five-week cycle. In
addition, certain medical assistants are also cross-trained in front-office
The center engages two of the 16
operations in order to provide vacation or emergency coverage in this
physicians as Co-Medical Directors at
area if needed.
any one time, in rotation. Each serves a
Long ago, the Board of Managers adopted a discretionary staff incentive
four-year term that is staggered by two
that has resulted in high productivity from the staff. On a quarterly basis,
the Board approves a pool of money that equates up to 3.0% of the entire
years in order to ensure an overlap of
ownership distribution for that period. This pool is then distributed to the
medical leadership at all times.
employees, based on merit and individual contribution levels to the success
of the operations. The staff therefore understand that their own earning
potential is directly tied to the financial performance of the center, which an Administrator with over 25 years of healthcare experience. A strong
means that circumstances such as add-on cases are welcomed and medical Assistant Administrator has direct responsibility for front-office
supply expenditures are closely monitored by the nursing personnel. operations, and a Charge Nurse oversees clinical operations.
Sedation Methodology Our staff are well trained and empowered to make decisions as
Nearly all patients undergo sedation with profofol administered by certified necessary. A recent Accreditation Association for Ambulatory Health Care
registered nurse anesthetists (CRNAs). A specialized team of nurse (AAAHC) surveyor commented on how smoothly the staff moved
anesthetists oversees the process, monitored by MD anesthesiologists. This patients between the different clinical areas within the facility.
allows the gastrointestinal proceduralist or colorectal surgeon to focus
entirely on the procedure. National Management Support
Our facility is supported nationally by Physicians Endoscopy, a highly
The center’s experience with profofol has been excellent. We have regarded endoscopy management company that also partners with 14
found that overall patient satisfaction for those receiving profofol is similar endoscopy centers. Although MEC is the highest-volume center
higher than that for procedures performed using other common within the group, the other centers average appropriately 9,000
sedatives on the market. In addition, each of our physicians has voiced procedures annually. Thus, our management partner is accustomed to
great support for the continued use of this sedation model. helping steward facilities that perform high caseload volumes.
Electronic Medical Records Comprehensive Physician Participation
The center has adopted a full electronic medical record (EMR) for patient The center engages two of the 16 physicians as Co-Medical Directors at
charts. In order to implement this system, a task force of personnel from any one time, in rotation. Each serves a four-year term that is staggered
84 US GASTROENTEROLOGY REVIEW 2007
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