Читать книгу Practical Pediatric Gastrointestinal Endoscopy - Группа авторов - Страница 26

The Society of Gastroenterology Nurses and Associates (SGNA) has published guidelines suggesting the minimum number of qualified personnel who should be allocated to various positions during endoscopic procedures [8]. Running a cost‐effective and safe endoscopic practice is a balance between appropriate staffing and the expense of maintaining that staff. Determining the number of staff needed to run the endoscopy unit is dependent on several factors. These include availability of equipment, time, types of procedures, complexity of patients, and presence of trainees. Maintenance of certification and licensing of endoscopy nurses are state specific in the United States (http://ce.nurse.com/RState Reqmnt.aspx). It would be prudent for the endoscopy unit to have annual assessments and training set up for all employees. A recent survey of pediatric centers suggests that more than 70% use an endoscopy RN and an endoscopy technician in the room during the performance of each procedure, and 100% use dedicated anesthesia staff [1].

Plans for after‐hours coverage should be determined for weekend and after‐hours emergencies. Based on a recent survey [1], 66% of US centers currently have a system in which a GI technician, a GI RN, or both are available on call. On‐call staff should be cross‐trained so that they can function well in all areas of the procedure. In some centers, general operating room staff assist with emergent after‐hours cases. These staff may not be trained in endoscopic procedures. Assigning a unit director is important in ensuring a focus on process improvement activities, and ensuring that equipment and services remain competitive.

It is important to recognize that an endoscopy unit should not target 100% efficiency, as this will lead to scheduling conflicts and decreased patient satisfaction. Instead, standard efficiency rates should be considered to be 70–85% [9]. The unit may have a dual purpose of serving both inpatient and outpatient populations, as opposed to an outpatient endoscopy center. It should therefore provide easy access to both types of populations. Optimizing turnover time should be a target for quality improvement initiatives as it impacts unit productivity. Patient no‐show may be an important barrier to improved efficiency. Preprocedure interventions have been shown to be effective in decreasing the no‐show rate [10]. On‐time starts and decreased turnover time can help maximize room efficiency [11]. Patient satisfaction surveys should be used as an indicator of quality of service. A recent study on patient experience in pediatric endoscopy identified important aspects from the patient and family perspective [12].

Documentation is an important aspect of endoscopy unit management. There are three broad areas of documentation: nursing documentation before and after procedure, the procedure itself, and sedation record. The Joint Commission on Accreditation of Healthcare Organizations provides guidance on components of documentation.