Green Spring Station Endoscopy, LLC

Winner of Innovation in Quality Improvement Award from AAAHC Institute for Quality Improvement

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Green Spring Station Endoscopy, LLC in Lutherville, Md., is a winner of the Accreditation Association for Ambulatory Health Care (AAAHC) Institute for Quality Improvement Innovation in Quality Improvement Award. The award, which debuted in 2004, recognizes exemplary initiatives that have positively impacted the quality of care in the ambulatory environment. The AAAHC Institute is a leader in providing ambulatory healthcare organizations opportunities to participate in respected clinical performance measurement studies and educational programs.

In the “Surgical/Procedural” category, for their study on “Reducing Scope Repair Costs,” Green Spring Station Endoscopy addressed the rising costs of endoscope repair and the role that the handling of endoscopes may have contributed to these costs. This study was important because new endoscopes cost more than $20,000 and repair costs at their center had risen by 50 percent over the past year.

To study the issue, Green Springs’ RNs and GI techs evaluated the endoscopy procedures at the center. They found that due to a recent change in the way the procedure room was staffed, more people were handling the scopes, and specific types of repairs were reoccurring.

To establish a benchmark for average repair costs, a network of other endoscopy centers in the community was formed, and the question of repair costs was studied.

The data gleaned from the study confirmed that Green Spring Station’s repair costs were out of the norm. As part of its intervention program, The facility researched several scope repair vendors and selected the company that offered additional valueadded services. With the selected vendor, staff and physician educational programs were developed. The following services were implemented: the staff received an in-service involving dissecting a scope to observe where damage could occur; broken parts were returned so staff understood the mechanism of damage; a vendor representative completed leak-testing competencies with the GI techs. The scope repair rep also spent a morning with several physicians discussing how their technique could decrease repair costs. Preventive maintenance was performed twice a year, to prevent inexpensive problems from becoming an expensive repair. Scope utilization was formally tracked so less frequent utilized scopes would be used.

After the intervention program was in place, Green Spring re-measured its scope repair costs. They found that scope repairs decreased from $12.33 to $10.26, saving the center $12,325 for the year.

“One of the real benefits of quality improvement studies is that it helps identify areas in need of re-evaluation and provides solutions to important operational issues. As a result of an intervention program with a team approach, we were able to make a valuable contribution to our cost containment program,” said Helen Rolf, RN, BSN, nurse manager at Green Spring Station Endoscopy, LLC.

A key to the success of the quality improvement study, according to Rolf, was the involvement of the entire staff and physicians. Staff education/awareness was a major factor in improvement; which takes time and commitment. Physician buy-in is also challenging. They prefer to use the latest and greatest scope making utilization of the total inventory of scopes difficult to implement. Most importantly, the staff needs to be rewarded for their efforts, without which change would not be possible.

To ensure ongoing success, the improvement program has been sustained. In addition, the Nurse Manager group (Greater Baltimore ASC Network) has expanded, and meet quarterly to ask questions and share their expertise on many quality improvement issues specific to ambulatory centers.

As a winner of the Innovation In Quality Improvement Award, Green Spring Station Endoscopy, LLC presented its case study and received a special award from the AAAHC Institute for Quality Improvement at its fourth annual National Quality Forum for Ambulatory Health Care, held Dec. 4-5, 2004, in Las Vegas.

“Our primary focus is patient safety,” says Rolf. “It’s a priority, but it’s also a given. I have excellent nurses who deliver excellent care. Endoscopes are delicate, they’re expensive and they can be a potential source of infection. They need to be handled with the utmost care.”

The Accreditation Association for Ambulatory Health Care established the AAAHC Institute in 1999 to provide ambulatory healthcare organizations opportunities to participate in clinical performance measurement studies and educational programs. To date, the AAAHC Institute has conducted and published 15 clinical performance measurement studies and has convened an annual national forum on quality improvement in ambulatory care.

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