Organization and Efficiency in the Endo Suite

Many factors can affect the efficiency of an endoscopy department. Organization of supplies and the nursing schedule, layout of the suite itself, and even reducing nurse turnover and maintaining a stable staff can improve how well the suite prospers, both clinically and financially. 

Organizing people to make them work more efficiently requires an organized environment, first and foremost, says Joyce Epps, RN, BSN, CGRN, lead nurse for the gastroenterology unit at Lenoir Memorial Hospital in Kinston, N.C. “The supplies, paperwork, etc., need to be within hands’ reach,” she adds. “The unit manager also needs to demonstrate organizational traits that the staff will want to inspire in themselves. Endoscopy nursing is a lot of routine repetitions, which helps one develop a pattern that others can easily articulate and emulate.” 

Certain non-technical items can be utilized as well, even in an environment that places a premium on technology. “A cart in our endoscopy unit, known as the ‘exchange cart,’ has been stocked by a professional supplier with syringes, tape, feeding tubes, PEG sets, snares and suction canisters, IV supplies, gowns, gloves and saline solutions,” says Marcia West, RN, staff nurse in the endoscopy department at Washington Hospital Health Care Systems in Fremont, Calif. 

“The items used on the cart are replaced daily, and this saves time for the nurses,” she adds. “Other items needed for procedures such as cautery unit equipment, gold probes, injectable probes, sclero needles and ERCP equipment are ordered most often through a vendor on a weekly basis. The charge nurse on our unit has been given this ‘official’ duty, as she deals with the reps for inservices, etc.” 

Weekly routines are established to monitor the crash cart, counting and changing locks, along with daily paddle checks. And the STERIS machines utilized for cleaning scopes require weekly tests for efficiency with a bacterial strip diagnostic test. Results that have been negative are recorded in a log book. Scopes in need of repair are recorded in a log book with serial number, time of incident and the amount of damage. “This enables us to troubleshoot scopes that are ‘frequent-flyers,” West observes. 

Organizing people to work more efficiently requires assigning people to specific jobs on specific days, she adds. “Flexibility is the key. Some days, the endoscopy lab is busier than others. If we have a busy Monday and it is the day for diagnostics on the STERIS, we can opt to do it the next day to keep our priority of serving the patients first. We utilize a grease board and have a list of all our scopes with serial numbers and types. When one scope is out for repair, the date is placed next to the listed scope, and if a loaner scope has been ordered, this, too, will be noted.” 

If equipment has been ordered, the staff members file the paperwork with the date of arrival. “Having each person knowing what needs to be done on any given day enables us to share the workload and know we are a part of the team,” says West. 

“A weekly chart of scope utilization may prove to be a helpful tool to record the amount of usage of one scope over another, as rotation of scopes may be a factor in wear and tear,” she continues. “The endo repair sheets provide a way of tracking the frequency of issues on scopes, enabling the hospital to better budget cost needs.” 

Efficiency in the unit is improved by paying close attention to the physician’s preferences for scopes, tools, and style, she adds. “

And because turnover from patient to patient in the room is important, one RN is giving a report to the staff nurse and the other is carting the patient back to the room, while the tech is cleaning the scope and wiping down the tables and tower for the next case. The operating word is ‘flexibility,’ because cases change. We have a protocol set that if the potassium is less than 3.0 on a patient, we hold the case, or if a conflict arises and the patient has another procedure such as dialysis, cathlab, or X-ray, we check with the staff nurse and coordinate with the doctors which one is priority to do first. We now have a cell phone to carry and communicate these issues with one another if such changes occur, and then the coordination of the new agenda takes place faster.” 

Because the endoscopy team travels to cases in the intensive care units, the cart must be restocked daily in anticipation of any and all needs. “Recently, we had a case with the ulcer in an awkward position in the duodenum, and we needed an ERCP scope to reach the area requiring cautery. We had not anticipated such an issue, but with three staff members attending, we were able to get the scope in record time, even though it was not with us at the time. In the future, bringing another scope could prove helpful.” 

The Digestive Center and the endoscopy center at Overlook Hospital in Summit, N.J., has also implemented some recent changes to make the workplace more efficient and organized. Cynthia Howard, RN, CGRN, clinical coordinator of endoscopy, and Mary Jo Miller, RN, CGRN, work in the endoscopy unit; Vicki Schmidt, RN, BSN, is the clinical coordinator of the digestive center, and Pat Schaedel, RN, is a digestive center nurse. 

One of the most obvious assets to a gastroenterology (GI) suite is the electronic medical record (EMR), which has been adopted by Overlook Hospital for its departments. “We can access the patient record any time, even if a physician calls us a year later,” the nurses say. “We have a lot of systems available online to keep everything organized and available. We have paperwork in each room, as well as small file separators to keep papers organized and at hand. Cindy does a calendar matrix for us monthly with everybody’s work schedule. We’re responsible for on-call service 24 hours a day, seven days a week, so we offer a huge calendar to sign up for call a month in advance. Each employee is required to sign up twice a month.” 

All of the necessary manuals are available online — standards, policies, procedures, infection control, and safety. Each staff member has a secure password and login for the computer, and they can log in and pull up a policy or procedure online. “We got away from the hard copies because they’re not kept up-to-date; they are up-to-date on line,” the Overlook Hospital nurses explain. 

Every nurse has a job and a responsibility. One nurse is assigned to check for expired drugs; one checks the crash cart and makes sure that the log is kept up-to-date. Someone orders supplies, and someone else unloads them and packs them up. A sign-up sheet is offered so that if a nurse notes a shortage of a supply, she can put a note on the clipboard, date it and initial it, and the ordering will be done on a daily basis. “Everybody has their individual jobs and that keeps them organized and ensures that things are where they should be,” the nurses add. 

They have found the unit functions more efficiently if they keep supplies in the same location in each procedure room, so staff members know where to find supplies in an emergency. “When you don’t know where you’re working, in ‘Endo 1’ today, and ‘Endo 4’ tomorrow, it helps if supplies in every room are in the same spot. We have some girls who only work one or two days a week, so they’re not here that often, and it is just easier to learn where things are if they’re kept in one spot,” they affirm. The unit offers a unique opportunity to improve workplace efficiency by allowing staff members to elect a project. The program, which is sponsored by the hospital, allows nurses and technicians to fulfill certain categories of service and teamwork above and beyond their normal daily routines. 

“One of our nurses for our pediatric population did a nice job with a pediatric cart,” the nurses relate. “She had it painted in primary colors, and on the outside it’s marked ‘pediatric.’. Each drawer is highly organized, with all the things we need for kids, such as IV tubing, IV solutions, little oral airways, diapers. When we have kids as patients, everything is at our fingertips. There is information laminated on the top, noting that ‘If a child weighs this, you can use this,’ for example. That nurse is one of the best organizers we have.” 

The nurses also have an organized bin for pediatric and adult foreign bodies. It is labeled and includes slots for tools that may be used in a foreign body extraction. There is also an intubation box for difficult airways for anesthesia, so there are blades, emergency medications, and other items anesthesia would need. “The anesthesia cart is kept where the procedures are done, so it is easily accessible to the four procedure rooms. In case they have to travel to the ICU or ER, they just grab that box and it’s stocked and ready to go,” they say. 

“Because we do 40 to 50 cases a day, we have to be organized. It has to run smoothly or you don’t get anything done,” they conclude.