Table 4.
Survey results using the Delphi method to examine potential endoscopy unit quality indicators for the Efficiency and Operations domain
| Leadership/strategic planning | 1st round voting (n = 35), median (%), 1 = strongly disagree, 5 = strongly agree |
2nd round voting (n = 25), median (%) |
|||
|---|---|---|---|---|---|
| Related to quality | Meaningful to measure (%) | Feasible to measure (%) | Compliance in own endoscopy unit (%) | Related to quality (%) | |
| Endoscopy unit has a defined leadership structure.∗ | 5 | 5 (66.7) | 5 (83.3) | 5 (77.8) | 5 (92.0) |
| Designated individual within the leadership hierarchy oversees quality.∗ | 5 | 5 (66.7) | 5 (69.4) | 5 (61.1) | 5 (84.0) |
| Mission statement incorporates and physician leadership champions a “culture of quality.” | 5 | 5 (61.1) | 4 (30.6) | 5 (63.9) | 5 (76.0) |
| Endoscopy unit participates in formal quality benchmarking. | 5 | 5 (63.9) | 5 (63.9) | 4 (37.1) | 5 (72.0) |
| Staff participates in appraisal of unit policies and daily operations and are encouraged to suggest improvements. | 5 | 5 (75.0) | 5 (61.1) | 5 (61.1) | 5 (72.0) |
| Endoscopy unit has a process in place to address unexpected operational challenges in a timely manner. | 5 | 5 (58.3) | 4 (41.7) | 4 (37.1) | 5 (68.0) |
| Endoscopy unit has a practice administrator with advanced business training or experience. | 4 | 3 (27.8) | 4 (27.8) | 5 (50.0) | 4 (48.0) |
| Endoscopy unit leadership has an annual strategic planning meeting. | 4.5 | 4 (25.0) | 5 (63.9) | 4 (28.6) | 4 (32.0) |
| Operations | Related to quality | Meaningful to measure (%) | Feasible to measure (%) | Compliance in own endoscopy unit (%) | Related to quality (%) |
|---|---|---|---|---|---|
| Endoscopy unit adheres to regulatory requirements, including federal, state, local, and institutional, with respect to facilities and operating space.∗ | 5 | 5 (83.3) | 5 (83.3) | 5 (91.7) | 5 (87.5) |
| Endoscopy unit has a policy on administering monitored anesthesia care (MAC) and moderate sedation. | 5 | 5 (64.7) | 5 (61.1) | 5 (51.4) | 5 (87.5) |
| Unit committee(s) structure includes effective governance with physician and other stakeholder participation. | 5 | 5 (86.1) | 5 (85.7) | 5 (88.6) | 5 (84.0) |
| Endoscopy unit has a quality assurance committee that develops and enforces quality standard policies, meets regularly, generates quality reports for the endoscopy center and leadership, and manages quality improvement projects.∗ | 5 | 5 (80.6) | 5 (63.9) | 5 (69.6) | 5 (72.0) |
| Unit has a process in place to regularly trend and adjust resource availability, including equipment, space, time, and staff (eg, procedures/room/day, number of endoscopes/room) | 5 | 5 (58.3) | 5 (61.8) | 4 (31.4) | 5 (68.0) |
| Endoscopy unit has a policy on the formal review and evaluation for new devices and equipment.∗ | 5 | 5 (55.6) | 5 (58.3) | 4 (33.3) | 5 (68.0) |
| Endoscopy unit staff (eg, technician, nurse) are cross-trained. | 5 | 5 (65.7) | 5 (63.9) | 5 (72.2) | 5 (64.0) |
| Key intervals of patient throughput in the endoscopy unit are measured (eg, room turnover time, recovery time). | 5 | 4 (47.2) | 5 (66.7) | 4 (42.9) | 5 (60.0) |
| Rate of “no shows” and canceled appointments or procedures. | 4 | 5 (52.8) | 5 (66.7) | 5 (52.8) | 5 (56.0) |
| Endoscopy unit has a policy for late-arriving staff (including physicians). | 5 | 5 (55.9) | 5 (58.8) | 4 (20.0) | 4 (32.0) |
| Endoscopy unit has a policy for late-arriving patients. | 4 | 4 (30.6) | 4 (31.4) | 3 (30.6) | 4 (28.0) |
| Rate of on-time first case start. | 4 | 4.5 (50.0) | 5 (66.7) | 4 (25.2) | 4 (28.0) |
| Rate of room turnover time (case complete to next case start time). | 4 | 4 (30.6) | 5 (63.9) | 5 (54.3) | 4 (28.0) |
| Timeliness | Related to quality | Meaningful to measure (%) | Feasible to measure (%) | Compliance in own endoscopy unit (%) | Related to quality (%) |
|---|---|---|---|---|---|
| Time from procedure request to procedure date for routine procedures is tracked. | 4 | 4 (38.9) | 4 (22.9) | 3.5 (19.4) | 4 (28.0) |
| Endoscopy unit has a system in place to classify endoscopy referrals into emergent, urgent, and routine categories. | 5 | 5 (47.2) | 4.5 (44.4) | 4.5 (36.1) | 4 (20.8) |
| Endoscopy wait times are communicated to the endoscopy team and made available to referring physicians. | 4 | 4 (27.8) | 4 (13.9) | 3 (23.5) | 3 (28.0) |
| Wait time for urgent and semiurgent (within 24 hours) procedures. | 4 | 4 (20.6) | 4 (25.7) | 3 (31.4) | 3 (28.0) |
Indicators that are shaded white had consensus reached on them (ie, median of “5” on the second round of voting for the relatedness parameter with ≥80% of respondents rating it a “5”) and were the 6 highest-rated indicators for this domain.
Note: Patients and payers did not participate in the voting process. Both groups were initially invited but opted not to participate.
∗
Mandated by national regulatory or accreditation standards.