Foreword: Endoscopic Operations: Delivering a Powerful Method with Efficiency and Quality xiii
Charles J. Lightdale
Preface: Optimizing Endoscopic Operations xv
Sunguk N. Jang and John J. Vargo
Current State and Future of Infection Prevention in Endoscopy 625
Bret T. Petersen
Gastrointestinal (GI) endoscopy units tend to be busy environments in which numerous categories of staff provide moderately complex procedural care to high volumes of patients. The prevention of infections of both patients and staff is a never-ending endeavor for both inpatient and outpatient environments. Necessary considerations must address patient-to-staff, staff-to-patient, environmental, and device-related transmission of infection. In addition to the typical environmental and interpersonal infection risks present in all medical environments, the major concern within the endoscopy suite relates to contamination and potential transmission via reusable devices and endoscopes. Our understanding of this ever-present issue has evolved over time and has become a major focus of scrutiny in the past 5 years. This significant problem has stimulated guidance and ingenuity by regulators, investigators, and industry. Most recently, the COVID-19 pandemic of 2020 to 21 has also added significant burdens to our infection control efforts in gastrointestinal endoscopy.
Managing Physician Fatigue 641
Physician fatigue, also known as burnout, is a highly prevalent but often underrecognized result of workplace stressors. The consequences of burnout can include poor work–life integration, isolation, depression, and suicide. As a result, an organization may experience high physician turnover, patient safety issues, malpractice suits, and financial losses. Physicians should be encouraged to play a role in their wellness by taking mental time away from work, pursuing hobbies, attending wellness programs, and ensuring quality time with family. Ultimately, it is an organization that must acknowledge physician burnout, identify risk factors, and invest in targeted interventions to prevent this immense threat to their stability.
Ergonomics of Endoscopy 655
Anna M. Lipowska and Amandeep K. Shergill
Optimal endoscopic operations incorporate ergonomic principles into the endoscopy environment benefiting endoscopists, endoscopy unit personnel, and patients. A high prevalence of occupational musculoskeletal injuries is well established among endoscopists and gastroenterology nurses. Ergonomics can be integrated into all facets of the endoscopy unit including scheduling, endoscopy unit design, training programs, and investment in technology. Preprocedure, intraprocedure, and postprocedure areas should aim to deliver patient safety, privacy, and comfort, while also supporting endoscopists and staff with adjustable rooms and effective work flows. Team-wide educational initiatives can improve ergonomic awareness. These strategies help mitigate risks for musculoskeletal injuries and can lead to increased productivity. The COVID-19 area brings novel challenges to endoscopy.
Endoscopic Supply Chain Management and Optimization 671
Ji Seok Park and Sunguk N. Jang
Endoscopy is a procedural specialty that incurs significant cost through its high usage of consumables. Thus, supply chain management and optimization in endoscopy can improve value-based care, by identifying areas of cost saving in device procurement. Creating a multidisciplinary supply chain management team, such as multidisciplinary endoscopic device committee (MEDC), suggests a way to optimize supply chain. The essential components of MEDC are physicians, clinical administration, and institutional supply chain. The physicians in the committee identify new products, define the value of products, lead the product acquisition decision-making process, and generate a practice guideline to define meaningful use of the product. The tasks of MEDC are product acquisition aligning with clinical care, review of meaningful use, and utilization of guidelines creation. In conjunction with group purchasing organization (GPO), which aggregates purchasing volume to leverage cost saving during negotiations, MEDC offers a model to optimize the endoscopy supply chain management.
The Role of the Gastrointestinal Hospitalist in Optimizing Endoscopic Operations 681
Edward Sun, Michelle L. Hughes, Sarah Enslin, Kathy Bull-Henry, Vivek Kaul, and Glenn D. Littenberg
The gastroenterology (GI) hospitalist model has improved endoscopic operations through improved interdisciplinary coordination, efficiencies introduced in endoscopy unit workflow, and increased patient access to both inpatient and outpatient GI care. The challenges and opportunities associated with a GI hospitalist model and supporting a GI hospitalist team are reviewed, especially in relation to advanced endoscopy. The roles of the GI hospitalist in endoscopy quality measurement and value-based care are also explored. Greater awareness of the GI hospitalist model and tailoring it to fit the needs of the GI practice or endoscopy unit will be key to practice sustainability and growth.
Navigating and Leveraging Social Media 695
Austin L. Chiang
Social media has made a noteworthy impact in health care both in public health efforts as well as transforming how physicians connect and exchange ideas. Learning how to navigate and leverage social media across multiple platforms is becoming increasingly difficult with more platforms and features constantly being introduced. Different physicians working in the same field will have different purposes behind getting on social media, but each physician plays a different role within this social media ecosystem. This article aims to identify the common benefits of health care social media use as well as navigate the unfortunate pitfalls of social media use.
The Future of the Private Gastroenterology Practice 709
Aaron J. Shiels and Joseph J. Vicari
The future private gastroenterology practice will be a large multidisciplinary practice including a clinic, AEC, pathology services, infusion services, anesthesia services, pharmacy services, and imaging centers. Delivery of gastrointestinal (GI) services will be a team-based clinic with AEC access and improved quality of care. Competing technologies will drive practices to promote the value of colonoscopy as the best screening test for colon cancer. Artificial intelligence (AI) may significantly alter our approach to clinic and endoscopic services. The creative and intellectual capital of practice leaders will continue to define the private GI practice of the future.
Developing Endoscopic Services in a Large Health Care System 719
John J. Vargo
The economic burden of health care in the United States continues to rise with no sign of letting up. The shift to value-based reimbursement offers a potential solution to maximize the outcome by pegging health care reimbursement to the quality of care provided. The service line concept of gastrointestinal disorders incorporates a multidisciplinary treatment model and maximizes the efficiency of patient-care giver encounters. The concept and implementation of a service line approach in endoscopy operation remain largely nascent even among large health care institutions. This article submits a multidisciplinary endoscopy operation model implemented in the author’s institution as a suggestion
Important Quality Metrics and Standardization in Endoscopy 727
Tossapol Kerdsirichairat and Eun Ji Shin
Quality metrics and standardization has become critical as the Affordable Care Act mandates that the Center for Medicare and Medicaid Services change reimbursement from volume to a value-based system. While the most commonly used quality indicators are related to that of colonoscopy, quality metrics for other procedures and endoscopy units have been developed mainly by the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy. Data to show that these quality metrics, especially in the field of advanced endoscopy as well as in the era of COVID-19 pandemic, can improve patient outcomes, are anticipated
Adoption of New Technologies: Artificial Intelligence 743
Jeremy R. Glissen Brown and Tyler M. Berzin
Over the past decade, artificial intelligence (AI) has been broadly applied to many aspects of human life, with recent groundbreaking successes in facial recognition, natural language processing, autonomous driving, and medical imaging. Gastroenterology has applied AI to a vast array of clinical problems, and some of the earliest prospective trials examining AI in medicine have been in computer vision applied to endoscopy. Evidence is mounting for 2 broad areas of AI as applied to gastroenterology: computer-aided detection and computer-aided diagnosis.
Role of Anesthesia in Endoscopic Operations 759
Utilization of anesthesia service in endoscopic operations can facilitate the procedural conditions and improve patient satisfaction. Comprehensive preprocedural/preanesthetic assessment should be preceded with focus on medical history, disorders that increase risk of aspiration, NPO status, ASA status, and airway evaluations, as these play an important role in perioperative complications. Preanesthetic assessment should serve as a guide to determining the appropriate depth of sedation for the patient, and indications for general anesthesia with endotracheal intubation should be reviewed. Finally, anesthesia care can be successfully implemented in ambulatory settings, including ambulatory surgery center and ambulatory endoscopy center with appropriate equipment and scheduling.
The Future of Endoscopic Operations After the Coronavirus Pandemic 773
The unprecedented COVID-19 pandemic and its rapid global shutdowns have posed tremendous challenges for GI practices, including sudden delays in endoscopic procedures. As full reopening approaches, practices are wrestling with completely retooling their operations to ensure the resumption of high-quality, safe, and effective patient care. The pandemic’s long-term effects on practice operations must be assessed: What will postpandemic GI care look like? Will some aspects of our work be changed forever, and if so, what are the practice management implications? This chapter surveys the pandemic’s impact on US-based GI practices and discusses key “lessons learned” for future operations.