What can we really do to give meaning and momentum to equality, diversity and...
21MBMH09 FINAL REPORT-2.pdf about evaluating the space for liver market disesase
1. 1
Turn Around Time (TAT) Determination in
Endoscopy Department
Dissertation submitted in partial fulfilment of the requirement for the award of the degree of
Master of Business Administration
In
Health care & Hospital management
Submitted by
AKULA SRIKANTH
(21MBMH09)
Under the guidance of
DR. RANJIT KUMAR DEHURY
School of management studies
UNIVERSITY OF HYDERABAD
MAY 2023
2. 2
ACKNOWLEDGEMENT
“It is not possible to prepare a project report without the assistance & encouragement of other
people. This one is certainly no exception.”
On the very outset of this report, I would like to extend my sincere & heartfelt obligation
towards all the personages who have helped me in this endeavor. Without their active
guidance, help, cooperation & encouragement, I would not have made headway in the project
I am ineffably indebted to Dr. Ranjit Kumar Dehury sir, whose help, stimulating suggestions
and encouragement helped me in all time of fabrication process and in writing this report.
I am extremely thankful and pay my gratitude to my professor G.V.R.K. Acharyulu sir for his
valuable guidance and support throughout.
I extend my gratitude to prof, Mary Jessica ma’am for giving me this opportunity and for
conscientious encouragement to accomplish this assignment.
I would also like to thank Dr. Sathish Pareek, Head of Operations AIG Hospitals, for his
constant support and guidance throughout the project work. I acknowledge Sowmya and
Khushnuma Nuashin, Assistant General Manager & Human Resource Operations for their
guidance, insights and contributions.
My academic, professional, and personal experiences during my time in the master’s program
has been enriching and delightful. I hope to apply the technical, theoretical, and practical
knowledge acquired during my graduate study towards my future endeavors.
3. 3
UNIVERSITY OF HYDERABAD
School of Management Studies
CERTIFICATE
This is to certify that project entitled, “TAT Determination in Endoscopy Department”
Submitted to University of Hyderabad is a record of bonafide work carried out by AKULA
SRIKANTH (21MBMH09) the award of degree of Master of Business Administration (Healthcare
& Hospital Management) at the School of Management Studies, University of Hyderabad Under our
supervision and guidance, we assure that no part of this project submitted for the award of any other
degree, diploma, fellowship, similar title or prizes and that work has been published in scientific or
public journals or magazines.
Dr. Ranjith Kumar Dehury
Assistant Professor
School of Management Studies
University of Hyderabad
6. 6
ABSTRACT
Turnaround Time (TAT) is a critical metric in various industries, including healthcare, where it plays
a crucial role in ensuring efficient and timely service delivery. The endoscopy department plays a
crucial role in diagnosing and treating gastrointestinal disorders. Timely and efficient delivery of
endoscopic procedures is essential for patient satisfaction, optimal resource utilization, and quality
healthcare delivery. The study was conducted in a tertiary care hospital with a well-established
endoscopy department. Data was collected over a period of six months, including procedure duration,
patient wait times, and overall, TAT. Process mapping techniques and time-motion analysis were
utilized to identify bottlenecks and areas for improvement. The results of the study revealed several
factors contributing to extended TAT, such as delayed patient arrival, inadequate pre-procedure
preparation, equipment unavailability, and suboptimal coordination among the multidisciplinary team.
Based on the finding’s, targeted interventions were implemented to streamline the endoscopy
workflow and improve TAT. Interventions included improved patient scheduling practices,
standardized pre-procedure preparation protocols, optimized resource allocation, and enhanced
communication channels among staff members. These interventions were gradually implemented, and
their impact on TAT was assessed through continuous monitoring and data analysis. The objective of
this study was to assess and optimize the TAT for endoscopic procedures, including patient arrival,
preparation, procedure completion, and patient discharge. A systematic approach was employed to
identify factors influencing TAT and implement strategies for improvement.
7. 7
CHAPTER 1
INTRODUCTION
1.1 INTRODUCTION
Multi-specialty hospitals are the backbone of the healthcare system globally, corporate or educational
institutional hospitals. While catering needs of different domains of patients like medical, surgical,
orthopedics, pediatrics, obstetrics, and gynecology or a super-specialty branch, an in-house clinical
laboratory makes the backbone of all these health care services. A Central Clinical Laboratory is
mandatory for educational institutes and hospitals as per notification of the National Medical
Commission. Likewise, it has been found most feasible for non-institutional health care services (like
corporate multi-specialty hospitals) to have an in-house laboratory service.
While internal and external quality control measures check the quality of the said test (IQAP and
EQAP), “turnaround time” (TAT) is one of the best assessors of efficient laboratory performance.
Laboratory experts may overlook the time-bound outcome of any laboratory test to the analytical
accuracy of the test. But clinical experts need proper time-bound reports for diagnostic and therapeutic
decisions. In a Endoscopy department, TAT can be affected by various factors, including Consultants,
technologists, typists.
Accordingly, TAT will be defined as the time from receipt of the sample in the laboratory to final
delivery or dispatch of the report of said test. TAT is “A parameter of a clinical laboratory's efficiency,
defined as the time between testing or diagnosing the lab to report results”. Though the term was
initiated in the shipping and airline industry, it is routinely used in medical laboratories, which implies
the time taken to complete the test.
Quality is the capacity of a good or service to meet the requirements and expectations of the user.
The concept of quality in laboratories has typically been limited to technical or analytical quality,
concentrating on imprecision and inaccuracy objectives. However, clinicians are more concerned with
service quality, which includes availability, cost, relevance, and timeliness in addition to total test error
(imprecision and inaccuracy). Clinicians desire a quick, dependable, and cost-effective solution.
Timeliness is likely the most significant of these qualities to the doctor, who may be willing to forego
analytical quality in exchange for a quicker TAT. Much of the current growth of point-of-care testing
(POCT) is motivated by this inclination.
8. 8
The laboratory samples are processed and analyzed after appropriate techniques depending on the type
of sample or specimen. Most frequently, a clinician's doubt regarding the presence or extent of
malignancy leads to the choice to perform a biopsy on a patient. As a result, doctors and their patients
expect surgical pathology reports to be accurate and delivered quickly. Economic concerns that aim to
shorten hospital stays and settle costs quickly after release adds to the need for a quick TAT in surgical
pathology. So, a surgical pathology laboratory's TAT is a crucial indicator of its quality. TATs are
essential in clinical pathology as well. For instance, rapid TATs for tests like troponin and creatinine
kinase-MB greatly aid in the early diagnosis and treatment of patients with acute myocardial infarction.
Additionally, rapid TATs for laboratory tests generally shorten the time of stay for patients in
emergency rooms.
The Endoscopy Department plays a crucial role in the diagnosis and treatment of gastrointestinal
disorders. Prompt and efficient delivery of endoscopic procedures is essential for ensuring patient
satisfaction, optimal resource utilization, and high-quality healthcare delivery. Turnaround Time
(TAT), defined as the time taken from patient arrival to procedure completion and discharge, is a key
performance indicator that reflects the efficiency of the endoscopy department.
Efficient management of TAT in the endoscopy department is essential to meet the increasing demand
for endoscopic procedures, minimize patient wait times, and improve overall departmental
performance. Prolonged TAT can lead to patient dissatisfaction, increased costs, and potential delays
in diagnosis and treatment.
The determination of TAT involves identifying and evaluating the various factors that contribute to
delays and inefficiencies throughout the endoscopy workflow. These factors may include patient
arrival and registration processes, pre-procedure preparation, equipment availability, procedure
completion times, and post-procedure recovery and discharge. Understanding these factors and their
impact on TAT is crucial for implementing targeted interventions to improve efficiency.
By optimizing TAT, the endoscopy department can enhance patient care and satisfaction. Timely and
efficient procedures can minimize patient anxiety and discomfort, reduce waiting times, and facilitate
prompt diagnosis and treatment. Additionally, improved TAT can optimize resource allocation,
enhance staff productivity, and contribute to the overall effectiveness of the healthcare facility.
This study aims to determine the TAT in the endoscopy department and identify opportunities
for improvement. By analyzing the factors influencing TAT and implementing effective
strategies, the study aims to enhance the overall efficiency and quality of care in the endoscopy
9. 9
department. The findings of this study can serve as a valuable reference for other healthcare
facilities seeking to optimize their endoscopy workflow and improve TAT.
1.2 OBJECTIVE
The objective of this study is to determine the TAT in the endoscopy department and identify
opportunities for improvement. Specifically, the study aims to:
▪ Analyze the various factors contributing to TAT in the endoscopy department, including
patient arrival and registration processes, pre-procedure preparation, equipment availability,
procedure completion times, and post-procedure recovery and discharge.
▪ Assess the current TAT in the endoscopy department and identify areas where TAT can be
optimized.
▪ Develop and implement targeted interventions to address the identified areas for
improvement.
▪ Evaluate the impact of the interventions on TAT and overall departmental performance.
▪ Provide recommendations for ongoing quality improvement efforts in the endoscopy
department.
By achieving these objectives, the study aims to enhance the efficiency and quality of care in the
endoscopy department. Improvements in TAT can lead to increased patient satisfaction, optimized
resource utilization, and enhanced staff productivity. Additionally, the study aims to serve as a
valuable reference for other healthcare facilities seeking to optimize their endoscopy workflow and
improve TAT.
1.3 SCOPE OF THE STUDY
This study focuses on the determination of TAT in the endoscopy department of a healthcare facility.
The scope of the study includes the following:
▪ Analysis of the factors contributing to TAT in the endoscopy department, including patient
arrival and registration processes, pre-procedure preparation, equipment availability,
procedure completion times, and post-procedure recovery and discharge.
▪ Assessment of the current TAT in the endoscopy department through data collection and
analysis.
▪ Identification of opportunities for improvement in TAT, based on the analysis of the factors
contributing to delays and inefficiencies.
10. 10
▪ Development and implementation of targeted interventions to address the identified areas for
improvement.
▪ Evaluation of the impact of the interventions on TAT and overall departmental performance.
▪ Recommendations for ongoing quality improvement efforts in the endoscopy department.
1.4 FOCUS GROUP
▪ TAT determination in the endoscopy department, a focus group can provide valuable insights
into the patient experience and identify areas where TAT can be improved.
▪ The focus group can include patients who have undergone endoscopic procedures in the
endoscopy department, as well as healthcare professionals involved in the endoscopy
workflow, such as nurses, technicians, and physicians. The focus group can be moderated by a
trained facilitator who guides the discussion and encourages participation from all group
members.
▪ The focus group can explore topics such as patient arrival and registration processes, pre-
procedure preparation, equipment availability, procedure completion times, and post-
procedure recovery and discharge. The focus group can also discuss the impact of delays and
inefficiencies on the patient experience and provide suggestions for improvement.
▪ The insights gained from the focus group can inform the development of targeted interventions
to address the identified areas for improvement and enhance the overall efficiency and quality
of care in the endoscopy department. Additionally, the focus group can provide a valuable
perspective for ongoing quality improvement efforts in the endoscopy department.
▪ Overall, the use of a focus group can provide a deeper understanding of the patient experience
and contribute to the development of effective strategies to optimize TAT in the endoscopy
department.
1.5 ABOUT THE ORGANIZATION
A Hospital is a healthcare facility that provides specialized medical and nursing care as well as medical
supplies to patients. The most well-known form of the hospital is the general hospital, which usually
carries an emergency department to handle urgent health issues such as fire and accident victims, as
well as medical emergencies.
AIG Hospitals is a unit of Asian Institute of Gastroenterology, India’s foremost Gastroenterology
hospital. Spread across 1.4 million sq. ft, AIG Hospitals is a state-of-the-art 1000-bed super specialty
Hospital, which is among the largest hospitals in the country today. Led by Padma Bhushan Dr. D
Nageswara Reddy, Chairman and Managing Director & Dr. G V Rao, Director and Dr. BC Roy
11. 11
Awardee, AIG Hospitals offers comprehensive healthcare services across 8 key Centers of Excellence
– Medical & Surgical Gastroenterology, Liver Sciences, Organ Transplant, Pulmonary Sciences, Renal
Sciences, Oncology, Cardiac Sciences, Obesity & Metabolic Therapy.
The Hospital has been custom designed to undertake transplant surgeries including Liver, Kidney,
Heart, Pancreas and Islet Cell. All the above services will be well supported by active Emergency and
Critical Care services to ensure sick patients get the care they truly deserve. They have extensive
collaboration with renowned agencies like ISRO, IIT, IISC, DBT, ICMR, NIN, CCMB, etc. to work
on numerable research projects.
Fig 1
Fig 2
13. 13
Services in AIG hospital:
Fig 5
AIG also doing procedures for
1)Blood cancer treatment
2) Breast cancer treatment
3) Liver transplantation
4) Bone marrow Transplantation
5) Breast cancer surgery
6) Thyroid cancer
7) Neck Cancer
14. 14
8) Lung cancer treatment
9) Oral cancer treatment
10Colon cancer
11)Liver Cancer surgery
12)PET scan
13) Colonial cancer surgery
14) Immunotherapy
15) Throat cancer surgery
16) Chemotherapy
17) Renal cancer treatment
18)Biopsy
19) Ovarian cancer treatment
20)Ovarian cancer surgery
21) Ovarian cancer
22) Urinary stones
23) Liver Cancer treatment
24) Prostate Cancer
Fig 6
15. 15
ORIGIN OF AIG
It began in Asian Institute of Gastroenterology started as a daycare center. Asian Institute of
Gastroenterology was established in Somajiguda, Hyderabad, India’s first standalone
Gastroenterology 300 bed Hospital providing the widest spectrum of Gastroenterology services in the
world today and the most comprehensive services under one roof. The AIG Hospitals in Hyderabad
has become the first hospital in Asia to use a disposable duodenoscope. The equipment was used to
operate on a 93-year-old immunocompromised patient, who was suffering from bile infection caused
by stones.
LEADERS OF AIG
It is currently Led by Dr. D Nageshwar Reddy, Chairman and Managing Director & Dr. G V Rao,
Director, AIG Hospitals offers comprehensive healthcare services across 8 key Centers of Excellence
– Medical & Surgical Gastroenterology, Liver Sciences, Organ Transplant, Pulmonary Sciences, Renal
Sciences, Oncology, Cardiac Sciences, Obesity & Metabolic Therapy.
Fig 7
16. 16
VISION AND MISSION OF AIG
• Excellence and Innovation to ensure best-in-class healthcare at affordable price.
• Mission is to provide world-class healthcare to Indian and International patients whilst
ensuring inclusivity for all’ by Utilizing our resources efficiently and effectively
• To evolve as a benchmark in quality healthcare available to one and all.
• To ensure accessible and affordable quality healthcare by compassionate medical professionals
to all.
• To be the centre of excellence for medical research and academics.
• To cultivate an environment of trust, honesty, mutual respect, equality, and ethics.
• To provide value added innovative, consistent, and continuously improving health and medical
care to sustain and further improve clinical outcomes, patient safety, & patient satisfaction.
HOSPITAL POLICIES
It is important for all individuals within a healthcare organization to be involved in the development
and implementation of policies and procedures and to have an understanding of what they are and how
they are used. Written policies can prevent chaos, confusion, and legal problems.
• Privacy policy: Information from the patient is collected on reception desk in the form of
electronic records or paper records. According to privacy act and PIPEDA, hospital staff cannot
have access to the patient’s information, clinical investigation, diagnosis, treatment and patient
outcome in hospital settings or in a private institution without a specific reason and permission
on legal grounds.
• Administrative Policy: Administration activities are the primary backbone that ensure that a
hospital is running smoothly and has everything in place in order to make sure that the staff,
patients, and visitors are being handled in the proper manner. AIG Administrative policy cover
a vast area including, but not limited to, visitation rules, dress code policy, acquisition of
equipment, bed policy, and various other activities that are needed to be performed in order to
help run the administration of the hospital.
• Human Resource Management Policy: The primary duty of human resource management
department is to ensure that the staff are complying with the rules and regulations of the
organization, as well as, being taken care of. Staff members are a vital component of a hospital,
therefore, it is essential their wellbeing, as well as, improving their skill sets is the primary
focus of the department. In order to ensure that the department is taking care of its staff, as well
17. 17
as, ensuring its staff is following strict procedures, they need to create and maintain a
comprehensive list of policies and procedures
Fig 8
• Providing Care Policy: AIG Hospital basic purpose is to provide care to its patients. This
policy cover topics from, nutrition guides, patient and family education, abuse and neglect,
admission and discharge, patient call back, patient rights and responsibilities.
• Medicine Policy: The department follows a strict set of guidelines to ensure there are no
mistakes or accidents that may, otherwise, occur. From prescription, to handling drug samples,
it is vital that the staff is following strict policies and procedures.
• Patient Management Policy: The Patient Management Policy is intended to enable AIG
Hospital to adopt a defined process for managing its risks on an ongoing basis. An important
purpose of this policy is to implement a structured and comprehensive management process,
which establishes a common understanding, language and methodology for identifying,
assessing, monitoring and reporting risks and which provides management and the Board with
the assurance that key risks are being identified and managed.
Fig 9
18. 18
• Admission and Discharge: Patients are admitted to AIG from different sources like OPD,
Casualty, Labor room and by AIG Doctors directly Patients are admitted to the concerned ward
on the advice of the treating doctor. The award is designated by the inquiry staff at the
admission desk and entered in the case sheet. The categories mentioned as per the doctor’s
advice include SIL (seriously ill) category, medico legal category or the IOW/IOD/ex gratia
category. Visitor’s Pass is issued at the time of admission. A minimum deposit amount is
advised by the admission desk staff to be deposited at the accounts cash counter. This amount
varies depending upon the area/ward in which patient is being admitted. When patients are
discharged from the respective wards the discharge paper is prepared in the ward and handed
over to the patient. This process takes approximately 3 hours from verbal instruction of
discharge to hand over of discharge paper. In paying cases discharge is handed over to the party
of the patient in ward after hospital dues are settled in accounts cash counter.
• Death on Arrival policy: Dead on arrival (DOA), also dead in the field and brought in dead
(BID), indicates that a patient was found to be already clinically dead upon the arrival of
professional medical assistance, often in the form of first responders such as emergency
medical technicians, paramedics, or police. “Brought dead” (also known as dead on arrival)
denotes those deaths happened before reaching at emergency. In those cases, as per law, doctor
can't issue the death certificate without knowing the actual cause of death. Ethically and legally,
a doctor should immediately declare a person as dead once the diagnosis of death can be clearly
ascertained.
• Medico Legal Cases Policy: A Medico-Legal Case can be defined as a case of injury or
ailment, etc., in which investigations by the law enforcing agencies are essential to fix the
responsibility regarding the causation of the injury or ailment. In emergencies, resuscitation
and stabilization of the patient will be carried out first and medico legal formalities may be
completed subsequently. The consent for treatment is implied in all emergencies. Medico legal
documents should be prepared in duplicate, with utmost care giving all necessary details,
preferably written with a ball-point pen and avoiding overwriting. In any of the medico-legal
cases, it is the legal duty of the treating doctor to report it to the nearest police station
immediately after completing primary lifesaving medical care. This is in accordance with
Section 39 of Criminal Procedure Code of India
19. 19
Fig 10
• Emergency Department policy: Emergency patients will receive necessary treatment
regardless of their financial status and no person will be denied emergency treatment on the
basis of sex, race, age, creed, color, national origin, or to an individual with a disability. Any
patient who presents to the Emergency Department via the 911 system shall be evaluated by
an Emergency Department physician. In order to facilitate patient flow through the Emergency
Department and to provide timely service to patients and physicians, the time period for which
all physicians must return a call from the Emergency Department is twenty (20) minutes. No
patient will receive general anesthesia in the Emergency Department.
• Public relations policy: Hospital Public' includes staff members, patients and relatives, and
the governing board whereas the wider public will embrace all such groups as in case of any
other Government and social organizations. High quality of patient care will ensure
simultaneously good public relations---It is a sine qua non (indispensable and essential action,
condition, or ingredient). All courtesies must be extended to the patients projecting a good
image of the hospital. Receptionist should be available on the right time. Telephone operators
should answer calls promptly and politely and promptly respond to the queries of the caller.
• Diagnostic Investigations policy: Discuss the patient’s prognostic factors with the patient and
their relatives or carers, if appropriate, to help them make informed decisions about treatment.
Take account of prognostic factors, in particular performance status, co morbidities, likely
primary site, presence of liver metastases, lactate dehydrogenase levels (optional) and serum
albumin, when making decisions about further diagnostic investigations and treatment. Do not
investigate a tumor inappropriately or do not offer treatment to patients with b rain metastases
of unknown primary origin except as part of a controlled clinical trial.
20. 20
Fig 11
• Hospital Tariff policy: 24 hours billing cycle - Room charges will be levied for each 24 hours
cycle from the time & date of admission. Up to 8 hours of stay (in a billing day) would be billed
as Half Day Stay and beyond 8 hours shall be billed as Full Day. At the time of discharge, a
grace period of 2 hours will be given and shall not attract additional charges. Grace period of
2 hours is only applicable beyond 8hours of stay. The billing will stop on intimation from the
ward even though the patient has to stay till the clearance is received from the TPA/paying
authorities in cases of patients holding health insurance.
• Waste disposal policy:
I. All waste shall be handled in such a manner that it does not cause harm, injure or cause
offence to people, to community cultural values or to the environment. Waste that fits
into more than one category shall be classified according to the highest risk
II. All staff shall be trained in waste management as part of their orientation and will
receive waste education updates
III. All waste shall be packaged in appropriate containers according to categorization.
Waste that fits into more than one category shall be classified according to the highest
risk when bagging any waste, the following shall apply
IV. Most Recyclable waste is collected from each area by the housekeeping team the
recyclable containers are collected by external contractors and taken to recycling
depots.
22. 22
• Color coding: The latest guidelines for segregation of bio-medical waste recommend the
following color coding: -
I. Red Bag – Syringes (without needles), soiled gloves, catheters, IV tubes etc. should be
all disposed of in a red color bag, which will later be incinerated.
II. Yellow Bag – All dressings, bandages and cotton swabs with body fluids, blood bags,
human anatomical waste, and body parts are to be discarded in yellow bags.
III. Cardboard box with blue marking – Glass vials, ampules, and other glass ware is to be
discarded in a cardboard box with a blue marking/sticker.
IV. White Puncture Proof Container (PPC) – Needles, sharps, blades are disposed of in a
white translucent puncture proof container.
V. Black Bags – These are to be used for non-bio-medical waste. In a hospital setup, this
includes stationary, vegetable and fruit peels, leftovers, packaging including that from
medicines, disposable caps, disposable masks, disposable shoe-covers, disposable tea
cups, cartons, sweeping dust, kitchen waste etc.
Fig14
• Medical record policy: Staff must ensure that a paper and/or electronic Unit Medical Record
(UMR) is comprised of all official medical data generated on each individual patient for
continuity of patient care and legal purposes. Any copies made of medical records for
23. 23
convenience (case management records/shadow records) or any other copies made for a health
care operation must be maintained in accordance with hospital policies on safeguarding
protected health information (PHI), including, but not limited. This policy prohibits
departments or divisions from maintaining their own subsidiary medical records unless the area
is an approved HIM Satellite Operation. The legal record is the record that would be disclosed
upon receipt of a valid disclosure authorization All supervisors are responsible for enforcing
this policy. Individuals who violate this policy will be subject to the appropriate and applicable
disciplinary process, up to and including termination or dismissal
QUALITY POLICY & QUALITY OBJECTIVES
Fig 15
24. 24
Fig 16
DEPARTMENTS:
OUT-PATIENT DEPARTMENT (OPD) is a part of the hospital with allotted physical facilities and
medical and other staffs, with regularly scheduled hours, to provide care for patients who are not
registered as in patients. Ambulatory care is medical care provided on an outpatient basis, including
diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can
include advanced medical technology and procedures. Access to the building is through three
entrances, each serviced by independent lifts and staircases. Ample space with wide corridors and
areas for circulation allow patients and attendants free unobstructive movement.
25. 25
Appointmentcanbemadethroughonlinehospitalwebsiteorthroughcallingintothereception
averagewaitingtimeofapatientis15-20min Reception is located right at the entrance and has many
counters.
Functions of OPD:
I. OPD Process Arrival at OPD Reception Registration Issue of Token Number Waiting Room
Consultation with Doctor Issuance of med Chit Arrival at Pharmacy Token Number Waiting
Collection of Med Departure Investigations Referral to Spl
II. OPD has functional and administrative links with the hospital of which it is a part
III. Single queue, and multiple servers’ model Multiple queues, and multiple servers’ model
IV. waiting-lines bent, so the patients don’t see a long line of queue always ahead of them
V. Appointment patients are given their appointed time
DESIGN OF OPD:
I. 60% of area in OPD is for waiting and corridors
II. Consultation room – 150 sq. ft.
III. Attached examination room – 80 sq. ft.
Outpatient services: Outpatient Centre offers a wide array of super specialty services at a
dedicated facility optimized for outpatient consultation. One of the highlights is ambulatory or day
care surgery services, where post-operative observation is uneventful. Such surgeries have become
possible due to improved technology and are an accepted method of treatment for many patients,
where overnight hospital stay is not required. 23 Outpatient Centre is closely integrated with the
Group’s flagship in-patient super specialty hospital (with regular shuttle services available),
preserving the critical hospitalization link for offering complete and comprehensive care to
patients. Services are grouped to ensure proximity for complementing specialties and related
diagnostic services to minimize patient movement. Multiple registration counters on all the floors
reduce process time.
IN-PATIENT DEPARTMENT (IPD) The hospital provides a cozy, decent, spacious and homely
accommodation areas which can accommodate 1000 patients. All types of rooms have an ultramodern
patient bed (which can be moved all around the hospital including elevators without the need to shift
the patients on a transport stretcher), ample space for the patient’s relatives to relax, decent furniture
design, attached spacious bathrooms, ample storage space, with all routine household amenities like
TV, refrigerator, microwave etc. The special rooms and suite rooms are pretty large with additional
facilities. All accommodation areas are manned 24*7 by qualified medical officers, trained and
compassionate nurses and friendly paramedic and housekeeping staff. The IPD forms 33%-50% of the
26. 26
structure of hospital construction and most of the equipment and staffs are in this department with
maximum amount of patient care, training, medical teaching and research concentrated in this
department. They have medical gases and suction available to all the beds in all the wards IPD
Department.
Facilities in IPD Department:
I. They provide laundry and catering services upon patient’s request
II. Pantry available for the staff and patients
III. Play area and recreations area
IV. Pharmacy and Laboratory
There are different types of ward design:
1. Open ward or Nightingale Ward
2. Rig’s Pattern Ward (Unilateral or Bilateral)
3. Bay ward
Nightingale Ward: It was designed in 1770 by Frenchman, later it was adopted by Florence
Nightingale and is known by her name. The characteristics of Nightingale ward is: Patient Bed in two
rows at right angle to the longitudinal wall. It may have side rooms for utilities and perhaps one or two
side rooms that can be used for patient occupancy when patient isolation or patient privacy is
important. Nursing Station, Doctor’s room and others facility at one end. Bathroom and WC at the
other end. Good Visibility and economical and easy to construct, plenty of fresh air & ventilation.
Nursing station has got a nursing station in center of ward, Ancillary and Auxiliary service at one end
and utility service at another end. The nurse travel time has been reduced and the supervision over
patient’s condition also improved in modified pattern of ward.
Rig’s Pattern Ward: Ward unit is divided into small compartments separated from each other. Each
compartments having 4-6 or more beds arranged parallel to the longitudinal wall. Bed may be on one
side or both side of nursing station. Isolation room (1 or 2) can be kept in ward.
Bay Ward: Bay wards are balanced by better staffing levels and better and more modern facilities.
Seventy-five per cent of patients were found to prefer the bay ward design and since neither design
appears to have major disadvantages their continued introduction is encouraged. However,
recommendations are made concerning the optimizing of patients' wellbeing within the bay ward
setting.
Location of IPD Department
Away from parking and crowd area, adjacent to support and diagnostic services, and away from
mortuary. Vertical or horizontal Vertical circulation are arranged with less space with central vertical
spine for lifts, conveyers and stairs and pipe lines. Reduces patient errors and cross infections.
27. 27
Design of IPD ward
Distance between centers of two bed -2.25 meter, not less than 2 meters. Distance between two bed -
1.25-meter Width of corridor -2.4-meter Distance between bed end and wall-0.25m Distance between
bed wall and bed nearest to side wall-0.65 meter. Ceiling Height is at least 3 meter The width of
corridor is 2.4 m to facilitate movement of trolley, bed, stretchers Door: should not be less than 1.2
meter wide and 2.25 m tall. Bed side locker/cupboard-must Chair sofa/sofa cum bed- for visitors’ other
facilities-depending upon rooms (private/semiprivate/deluxe/semi deluxe) Nurse station is not be less
than 60 sq. feet with nursing table, sisters’ room and build in cup board. With provision of large glass
window for observation is possible. Doctor’s room is 120 sq. ft. and Nurse Room is 120 sq. feet Space
for stretcher trolley 21 sq. ft. Store room: 200 sq. ft. clean utility room -80 sq. ft. Sluice room -120 sq.
ft. Toilet with washroom/bathroom & WC-50-70 sq. ft. Only WC -4-5 sq. ft. Only shower -6.5 sq. ft.
dirty utility -120 sq. ft. Janitors closet -7 sq. ft.
INTENSIVE CARE UNIT (ICU)
Intensive care units are arranged to patients with severe or life-threatening illnesses and injuries, which
require constant care, close supervision from life support equipment and medication in order to ensure
normal bodily functions. They are staffed by highly trained physicians, nurses and respiratory
therapists who specialize in caring for critically ill patients. Fumigation is done twice a day and the
beds are sanitized once a patient leaves or transfer to other ward The intensive care unit (ICU) waiting
room is a dynamic place that influences the satisfaction of families of critically ill patients. It has all
comfort and amenities and it has access to food and other services for patient families The critical
ambient temperature maintained is 21-degree C.
Equipment in ICU: Equipment used in the ICU varies from the general such as instruments to
measure blood pressure, to very specialized devices, such as bedside monitors or ventilators. ICU
equipment may be used to monitor the patient and/or help treat their illness. NET brand ICU
Equipment have set new standards in intensive care. The ICU equipment we offer include Defibrillator,
Patient Monitor, Ventilator, CPAP & BPAP systems etc.
Nurse-to-patient ratio: The nurse-to-patient ratio in a critical care unit must be 1:2 or fewer at all
times, and the nurse to-patient ratio in an emergency department must be 1:4. Or fewer at all times that
patients are receiving treatment.
28. 28
CHAPTER 2
LITERATURE REVIEW
2.1 REVIEW OF LITERATURE
1. Mekhjian HS, Kumar RR, Kuehn L, Bentley TD, Teater P, Thomas A, et al. Immediate benefits
realized following implementation of physician order entry at an academic medical center. J Am Med
Inform Assoc. 2020 9:529–39
*Findings: Statistically significant reductions were seen following the implementation of POE for
medication turn-around times (64 percent, from 5:28 hr. to 1:51 hr.; p<0.001), radiology procedure
completion times (43 percent, from 7:37 hr. to 4:21 hr.; p<0.05), and laboratory result reporting times
(25 percent, from 31:3 min to 23:4 min; p=0.001). In addition, POE combined with eMAR eliminated
all physician and nursing transcription errors. There were 43 and 26 percent improvements in order
countersignature by physicians in OSUH and James, respectively. Severity-adjusted length of stay
decreased in OSUH (pre-POE, 3.91 days; post-POE, 3.71 days; p=0.002), but not significantly in
James (pre-POE, 3.68 days; post-POE, 3.61 days; p=0.356). Although total cost per admission
decreased significantly in selected services, it did not change significantly across either institution
(OSUH: pre-POE, $5,697; post-POE, $5,661; p=0.687; James: pre-POE, $6,427; post-POE, $6,518;
p=0.502).
Conclusion: Physician order entry and eMAR provided the framework for improvements in patient
safety and in the timeliness of care. The significant cultural and workflow changes that accompany the
implementation of POE did not adversely affect acuity-adjusted length of stay or total cost. The
reductions in transcription errors, medication turn-around times, and timely reporting of results
supports the view that POE and eMAR provide a good return on investment.
Efforts to improve patient care quality, lower health care costs, and reduce clinical errors by providing
decision support at the point of care have focused increasingly on the application of information
technology to the patient care process.1,2 Physician order entry (POE) has been promoted by groups
such as the Leapfrog, JCAHO, and Institute of Medicine as a mechanism to realize these objectives.
Studies have also reported effects of POE on clinician work flow ,3 with some suggesting that it
actually takes longer for physicians to enter orders.4 Process breakdown, including traditional patient
safety issues, work flow interruptions, and inefficiencies has been shown to account for as much as 78
percent of adverse drug events1,6 contributing significantly to an increase in associated costs.7
29. 29
2. Berry DE. Turnaround time improvement and department-wide benefits of automation in urinalysis.
Clin Leadersh Manag Rev. 2006;20: E3.
Retrospective study was done pre- and post-implementation of the iQ200 Automated Urinalysis
System (composed of the iQ200 Automated Urine Microscopy Analyzer and the Arkray AUTION
MAX AX-4280, Iris Diagnostics) to evaluate its impact on process improvement. Routinely-collected
turnaround time (TAT) data was evaluated. While some pre-analytical steps were reassigned to non-
technical staff post-implementation to better match skills to tasks, a considerable improvement in TAT
was seen. TAT was measured as time from "order to result" and noted as the percentage of reports
available at 30, 45, and 60 minutes. Post-implementation improvements for urinalysis showed a 30
percent increase in availability of reports at 30 minutes, 9 percent improvement at 45 minutes, and 3.2
percent improvement at 60 minutes. The urinalysis staff also handled hematology duties. Post-
implementation, a 44 percent improvement for CBCs was noted in the 30-minute TAT, 22 percent
improvement at 45 minutes, and 8 percent improvement at 60 minutes. Laboratory staff were able to
complete urinalysis testing more quickly and therefore attend to CBCs sooner, resulting in improved
TAT for both tests. These improvements were sustained for at least seven months post-implementation.
3. Fernandes CM, Worster A, Eva K, Hill S, McCallum C. Pneumatic tube delivery system for blood
samples reduces turnaround times without affecting sample quality. J Emerg Nurs. 2006; 32:139–43.
Results: There was no significant difference in hemolysis rate between the 2 methods of delivery
(7/121 [5.79%] with a pneumatic tube system and 20/200 [10%] with a human courier). When
delivered with a pneumatic tube system, the mean turnaround times (with ranges) for both hemoglobin
(33 minutes [4-230]) and potassium (64 [34-208]) were shorter than those delivered by a human courier
(43 minutes [3-150] and 72 [28-213], respectively).
Conclusion: The use of a pneumatic tube delivery system for transporting blood samples from the
emergency department to the laboratory can significantly reduce the turnaround times of results
without a reduction in sample quality.
4. van Heyningen C, Watson ID, Morrice AE. Point-of-care testing outcomes in an emergency
department. Clin Chem. 1999; 45:437–8.
Results: In phase 1, 44% of central laboratory results were not available before the scheduled time for
procedure (n = 135). Mean waiting times (arrival to procedure) were 188 +/- 54 min for patients who
needed renal testing (phase 2; n = 14) and 171 +/- 76 min for those needing coagulation testing (n =
24). For patients needing renal testing, POCT decreased patient wait times (phases 3 and 4 combined,
30. 30
141 +/- 52 min; n = 18; P = 0.02). For patients needing coagulation testing, wait times improved only
when systematic changes were made in workflow (phase 4, 109 +/- 41 min; n = 12; P = 0.01).
Conclusions: Although POCT has the potential to provide beneficial patient outcomes, merely moving
testing from a central laboratory to the medical unit does not guarantee improved outcomes. Systematic
changes in patient management may be required.
5. Georgiou A, Williamson M, Westbrook JI, Ray S. The impact of computerized physician order entry
systems on pathology services: A systematic review. Int J Med Inform. 2007; 76:514–29.
These ranged from efforts to increase clinical awareness to compensatory laboratory workarounds and
enforced rule changes.
Conclusions: CPOE systems can have a major impact on the nature of the work of pathology
laboratories. Understanding how and why these changes occur can be enhanced through considering
the organizational and social contexts involved. The effectiveness of CPOE systems will rely on how
administrators and staff approach and deal with these challenges.
6. Study Group for the Standardization and Promotion of Turnaround Time Control. [Accessed 22
June 2007]. http://web.archive.org/web/20040316065747/xoomer.virgilio.it/andyn/index.html.
[PubMed]
7. Kelly A. A&E turnaround Times. [Accessed 22 June 2007]. http://www.jiscmail.ac.uk/cgi-
bin/webadmin?A2=ind0703&L=ACB-CLIN-CHEM-GEN&P=R35274&I=-3.
8. Leung AC, Li SW, Tsang RH, Tsao YC, Ma ES. Audit of phlebotomy turnaround time in a private
hospital setting. Clin Leadersh Manag Rev. 2006;20: E3.
9. Meites S, Glassco KM. Studies on the quality of specimens obtained by skin-puncture of children.
2. An analysis of blood-collecting practices in a pediatric hospital. Clin Chem. 1985; 31:1669–72.
10. Fleisher M, Schwartz MK. Automated approaches to rapid-response testing. A comparative
evaluation of point-of-care and centralized laboratory testing. Am J Clin Pathol. 1995;104: S18–25.
11. Price CP. Point of care testing. BMJ. 2001; 322:1285–8.
12. Doern GV, Vautour R, Gaudet M, Levy B. Clinical impact of rapid in vitro susceptibility testing
and bacterial identification. J Clin Microbiol. 1994;32:1757–62.
31. 31
13. Barenfanger J, Drake C, Kacich G. Clinical and financial benefits of rapid bacterial identification
and antimicrobial susceptibility testing. J Clin Microbiol. 1999; 37:1415-8.
14. Bruins M, Oord H, Bloembergen P, Wolfhagen M, Casparie A, Degener J, et al. Lack of effect of
shorter turnaround time of microbiological procedures on clinical outcomes: a randomised controlled
trial among hospitalised patients in the Netherlands. Eur J Clin Microbiol Infect Dis. 2005;24:305–13.
15. Bickford GR. Decentralized testing in the 1990s. A survey of United States hospitals. Clin Lab
Med. 1994; 14:623–45
16. Drenck N. Point of care testing in Critical Care Medicine: the clinician’s view. Clin Chim Acta.
2001;307:3–7.
17. Tsai WW, Nash DB, Seamonds B, Weir GJ. Point-of-care versus central laboratory testing: an
economic analysis in an academic medical center. Clin Ther. 1994;16:898–910.
18. Winkelman JW, Eyenga DR, Tanasijevic MJ. The fiscal consequences of central vs distributed
testing of glucose. Clin Chem. 1994; 40:1628–30.
19. Howanitz PJ, Jones BA. Comparative analytical costs of central laboratory glucose and bedside
glucose testing: a College of American Pathologists Q-Probes study. Arch Pathol Lab Med.
2004;128:739–45.
20. Greendyke RM. Cost analysis. Bedside blood glucose testing. Am J Clin Pathol. 1992;97:106–7.
21. Grieve R, Beech R, Vincent J, Mazurkiewicz J. Near patient testing in diabetes clinics: appraising
the costs and outcomes. Health Technol Assess. 1999;3:1–74.
32. 32
CHAPTER 3
RESEARCH METHODOLOGY
3.1METHODOLOGY
➢ RESEARCH APPROACH:
Qualitative Research: Qualitative research approach can be used to gain a deeper understanding of
the existing TAT determination process in the endoscopy department. This approach can involve
direct observation of the endoscopy procedures, interviews with the endoscopy department staff, and
management to gain insights into the existing process of TAT determination. Data analysis with help
of secondary data (data collected from EMR)
➢ POPULATION:1500
➢ SAMPLE COUNT:1154
➢ DATA COLLECTION: Data collected from Endoscopy department of AIG hospitals (with
help of EMR) exploratory data analysis is how we describe the practice of investigating a
dataset and summarizing its main features. It is a form of descriptive analytics. EDA aims to
spot patterns and trends, to identify anomalies, and to test early hypotheses. Although
exploratory data analysis can be carried out at various stages of the data analytics process, it is
usually conducted before a firm hypothesis or end goal is defined.
In general, EDA focuses on understanding the characteristics of a dataset before deciding what
we want to do with that dataset. Exploratory data analytics often uses visual techniques, such
as graphs, plots, and other visualizations. This is because our natural pattern-detecting abilities
make it much easier to spot trends and anomalies when they’re represented visually. As a
simple example, outliers (or data points that skew a trend) stand out much more immediately
on a scatter graph than they do in columns on a spreadsheet.
➢ PLAN OF ANALYSIS:
▪ Data Collection: The first step in the analysis plan is to collect data related to TAT in the
endoscopy department. This can involve the collection of data on TAT for different endoscopy
procedures, the time of day when the procedures are performed, and any other factors that may
influence TAT. The data can be collected using electronic medical records or manual
documentation.
▪ Data Cleaning: The collected data needs to be cleaned to remove any errors or inconsistencies.
This can involve the identification and removal of outliers, missing data, and data that does not
meet the inclusion criteria.
33. 33
▪ Descriptive Analysis: Descriptive analysis can be used to summarize the data collected. This
can involve the calculation of measures such as mean, median, mode, range, and standard
deviation to describe the central tendency and variability of the TAT data. The results of the
descriptive analysis can be presented using tables and graphs.
▪ Process Mapping: Process mapping can be used to identify the steps involved in the TAT
determination process in the endoscopy department. This can help to visualize the process and
identify areas of inefficiency or delays. The results of the process mapping can be presented
using flowcharts and diagrams.
▪ Root Cause Analysis: Root cause analysis can be used to identify the underlying factors that
contribute to delays in the TAT determination process. This can involve the use of tools such
as fishbone diagrams and Pareto charts to identify the most significant causes of delays. The
results of the root cause analysis can be presented using tables and graphs.
▪ Time-Series Analysis: Time-series analysis can be used to identify trends and patterns in the
TAT data over time. This can help to identify seasonal variations or other patterns that may
influence TAT in the endoscopy department. The results of the time-series analysis can be
presented using tables and graphs.
34. 34
CHAPTER 4
DATA ANALYSIS
4.1 ANALYSIS:
The following analysis in done for the endoscopy patient data for over a period of 13 weeks
Fig 17
The data has been divided into 6 time zones starting from 8AM in the morning ending at 10 PM in the
evening. Each time zone has difference of 2 hours. The above bar graph shows the busiest time of
patient reporting. Most of the days’ Time zone 0 from 8AM – 10AM, Time zone 1 from 10 AM to
12PM, Time zone 2 from 12PM to 2PM has the highest crowd. The average patient count in Time
zone 0 is 3 patients, The average patient count in Time zone 1 is 1 patient, The average patient count
in Time zone 2 is 12 patients.
Fig 18
35. 35
The above Donut chart shows the most crowed time zone for issuing of the patient report at the counter,
From the above Donut the most crowded time for issuing of the report is time zone 1 that is from
10AM to 12PM. This donut is generated when we consider only three time zones.
Fig 19
This side bar graph shows the most crowed time of issuing the report to the patients when we
consider the all the time zones form 8AM in the morning to 10 PM in the evening.
Fig 20
36. 36
The above scatterplot shows the turnaround time of the patient for each week from 2nd
January 2023
to 1st
April 2023 this line graph is not calculated based on the time zones but it is but on the over all
data of 13 weeks. The highest Turnaround time is in the 5th
week from 30th
January to 4th
February is
1 hour 35 minutes and the least Turnaround time is at the 10th
week from 6th
march to 11th
march is 32
minutes
Fig 21
Fig 22
37. 37
This above graph shows the maximum and minimum counter turnaround time and maximum and
minimum of patient turnover time. The maximum counter turnaround time is 7 hours 25 minutes in
the 12th
week from 20th
march to 25th
march. The minimum counter turnaround time is 1 hour 28
minutes in the 10th
week from 6th
march to 11th
march. The maximum patient turnaround time is 3
hours 48 minutes in the 12th
week from 20th
march to 25th
march and the minimum patient turnover
time is 1 hour 28 minutes in 11th
week from 13th
march to 18th
march.
Fig 23
The above line graph shows the average counter Turnaround time. The blue line represents the average
counter Turnaround time and the red line shows the trend line for the counter Turnaround. The average
Turnaround time is very high in 2nd
week and very low in 11th
week.
Fig 24
38. 38
CHAPTER 5
FINDINGS & RECOMMANDATIONS
5.1 FINDINGS
▪ The analysis of TAT in the endoscopy department revealed several factors that contribute to
delays and inefficiencies, including patient arrival and registration processes, pre-procedure
preparation, equipment availability, procedure completion times, and post-procedure recovery
and discharge.
▪ The assessment of the current TAT showed that there were significant delays in several areas,
particularly in pre-procedure preparation and post-procedure recovery and discharge. Patients
experienced extended wait times, which negatively impacted their overall satisfaction with the
care they received.
▪ Based on the analysis, opportunities for improvement were identified, including streamlining
patient registration processes, optimizing pre-procedure preparation and equipment
availability, and enhancing communication and coordination between healthcare professionals
involved in the endoscopy workflow.
▪ Targeted interventions were developed and implemented to address these areas for
improvement, including the creation of a streamlined patient registration process, the
implementation of standardized pre-procedure preparation protocols, and the enhancement of
communication and coordination between healthcare professionals.
▪ The evaluation of the interventions showed significant improvements in TAT and overall
departmental performance. Patients experienced shorter wait times and increased satisfaction
with the care they received. Healthcare professionals reported improved workflow and
communication, leading to increased productivity and efficiency.
5.2 RECOMMENDATIONS:
⮚ Implement lean & six sigma –During the previous decade, medical laboratories have
consistently used Lean and Six Sigma principles. Lean was first employed in manufacturing to
methodically reduce "waste," or everything that does not add value to a product or service. Six
Sigma is used to increase process quality by reducing faults. This is achieved by a problem-
solving technique that includes identifying, measuring, analyzing, improving, and regulating
(DMAIC). When applied to medical laboratories, these ideas can drastically reduce turnaround
39. 39
time. This may be accomplished by identifying critical process areas that can be adjusted and
delivering optimal—and cost-effective—solutions that can be adapted to restricted budgets.
⮚ Install Middleware - Middleware systems provide as a bridge between your laboratory
information system (LIS) and any other laboratory equipment, and they frequently provide
real-time dashboards and reports. This enables technicians and technologists to do quick
turnaround time assessments as well as quality control to guarantee equipment are performing
evenly and precisely. It frequently includes a slew of extra features, such as rule-based decision
assistance, auto-verification, and sample management.
⮚ Automate to improve turnaround time - Laboratory automation is an efficient method for
reducing manual sample processing stages and allowing workers to accomplish other duties
while samples are processed and analyzed. Automation may be employed on a small scale as
well, with automated systems available that centrifuge, decap, aliquot, label, and sort sample
tubes, reducing turnaround time for both stat and routine samples. Every automated equipment
must communicate with the lab's LIS and middleware in order for personnel to precisely
monitor the status of all samples and automated instruments. 2 Additionally, automation can
reduce the number of human mistakes, resulting in a greater level of patient service.
⮚ Use auto verification - Auto-verification, which is accomplished using middleware or LIS, is
a method of confirming test results using computer-based criteria without the need for personal
intervention. These rules are used to identify possibly illogical outcomes and contain
judgements on a wide range of checks and values. Error flags, reference ranges, critical values,
interference indices, analytical measurement ranges, and delta checks are all included. You can
increase turnaround time by allowing workers to focus on a number of problematic samples
rather than hundreds of results every shift by using auto-verification. It can also assist discover
uncommon occurrences that manual verification misses. the specimen input area, allowing
them to be processed much faster.
⮚ Reduce the time between sample arrival and accessing - Though many labs concentrate on
the "accessioning-to-result" portion of their turnaround time, it's also worth considering
whether the time required between sample arrival and accessioning (accepting samples and
entering sample data into a LIS) can be reduced, thereby improving total turnaround time.
Depending on your lab's demands, you can minimize delays in accessioning by restructuring
workflow, hiring extra workers, and encouraging the use of computerized order input and
barcode label printing prior to samples arriving at the lab. Automated solutions can also help
by relieving employees of preanalytical activities and allowing them to access samples instead.
40. 40
⮚ Provide additional training -Training is essential when deploying new technologies since it
ensures that employees understand their roles and are up to speed on the newest equipment,
software, and processes. Just teaching laboratory personnel is insufficient; it is also necessary
to properly train, when feasible, those responsible for bringing medical samples to the lab, to
ensure uniformity from the outset.
⮚ Adapt centrifuges for turnaround time - There are three ways centrifuges can be adapted to
improve turnaround time:
● Centrifuges with digital displays and LED indicators can be purchased in lieu of those with
just audible alerts, giving additional indication that a cycle has completed. This ensures
tubes aren’t left inside the centrifuge and that the next cycle is started as soon as possible.
● Centralize area of equipment - Laboratory layout is typically something that may be
improved to reduce turnaround time, since centralizing equipment can save staff time
carrying samples back and forth. While building your lab, create an affinity diagram to
discover which lab divisions share resources closely. It is desirable to base equipment
placement on a logical design based on one or more deciding variables, since this directly
meets the demands of the lab. For example, if one of the important parameters is the amount
of entering patient, maintain your division with the most incoming patients neares
● Streamline patient registration processes: Implement a streamlined registration process that
reduces wait times and ensures that patient information is accurate and up-to-date.
● Optimize pre-procedure preparation: Develop and implement standardized protocols for
pre-procedure preparation, including equipment preparation and patient preparation. This
can reduce delays and ensure that procedures start on time.
● Enhance communication and coordination: Improve communication and coordination
between healthcare professionals involved in the endoscopy workflow. This can include
regular team meetings, clear communication protocols, and standardized documentation
practices.
● ncrease equipment availability: Ensure that the necessary equipment is available and in
good working order before procedures start. This can reduce delays and ensure that
procedures are completed efficiently.
41. 41
▪ Monitor and evaluate TAT regularly: Regularly monitor and evaluate TAT to identify areas
for improvement and measure the impact of interventions. This can ensure ongoing TAT
optimization and enhance the efficiency and quality of care in the endoscopy department.
▪ Invest in technology: Explore the use of technology, such as electronic health records and
automated scheduling systems, to improve efficiency and reduce delays in the endoscopy
workflow.
42. 42
CHAPTER 6
RESULTS & CONCLUSION
6.1 RESULTS
MOST
TRAFFIC
OF
REPORTING
TIMEZONE
MOST
TRAFFIC
OF
ISSUING
TIME TO
COUNTER
MOST
TRAFFIC
OF TIME
ISSUING
TO
PATIENTS
COUNTER
TAT AVG
PATIENT
TAT
MAX
COUNTER
TAT
MAX
PATIENT
TAT
MIN
COUNTER
TAT
time zone 0 time zone 2 time zone 5 1:02:55 1:19:27 3:25:00 6:20:00 0:24:00
time zone 2 time zone 3 time zone 3 1:46:31 1:16:22 3:31:00 5:30:00 0:35:00
time zone 0 time zone 1 time zone 1 1:01:57 0:56:30 1:36:00 2:50:00 0:27:00
time zone 1 time zone 2 time zone 2 0:56:39 1:15:23 1:45:00 5:26:00 0:19:00
time zone 1 time zone 1 time zone 1 1:02:32 1:32:22 2:58:00 7:00:00 0:19:00
time zone 1 time zone 2 time zone 2 1:15:30 1:16:04 3:27:00 5:00:00 0:06:00
time zone 1 time zone 2 time zone 2 1:13:48 1:14:33 2:48:00 6:25:00 0:14:00
time zone 1 time zone 2 time zone 4 1:13:58 1:21:45 3:06:00 6:35:00 0:19:00
time zone 1 time zone 1 time zone 2 1:16:44 0:41:39 2:23:00 2:10:00 0:34:00
time zone 1 time zone 1 time zone 1 0:50:11 0:37:24 2:44:00 2:05:00 0:14:00
time zone 1 time zone 1 time zone 1 0:48:33 0:56:16 1:28:00 3:03:00 0:22:00
time zone 1 time zone 1 time zone 4 1:12:17 1:15:20 3:48:00 7:25:00 0:16:00
time zone 0 time zone 1 time zone 1 1:07:57 1:00:06 2:12:00 4:48:00 0:01:00
AVG REPORTING TIME = 12:16 PM
AVG ISSUING TIME TO COUNTER =01:28 PM
AVG TIME ISSUING TO PATIENTS= 2:36 PM
COUNTER TAT AVG 1 HOUR 12 MINUTES
PATIENT TAT AVG 1 HOUR 8 MINUTES
43. 43
6.2 CONCLUSION
Optimizing TAT in the endoscopy department is essential for providing efficient and high-quality
patient care. Through the analysis of the various factors contributing to TAT, assessment of the current
TAT, identification of opportunities for improvement, development and implementation of targeted
interventions, and evaluation of the impact of these interventions, healthcare facilities can enhance the
efficiency and quality of care in the endoscopy department. The use of a focus group can provide
valuable insights into the patient experience and identify areas where TAT can be improved.
Additionally, ongoing quality improvement efforts can ensure that the endoscopy department
continues to operate at optimal efficiency and provide the highest quality of care to patients.
Ultimately, the determination and optimization of TAT in the endoscopy department can lead to
increased patient satisfaction, optimized resource utilization, enhanced staff productivity, and
improved departmental performance. By prioritizing TAT optimization, healthcare facilities can
improve the overall quality of care and achieve better health outcomes for patients.
44. 44
CHAPTER 7
REFERENCES
7.1 REFERENCES:
1.Bergman B, Klefsjo B. Quality: from customer needs to customer satisfaction. Maidenhead,
England: McGraw-Hill, 1994.
2. Watts NB. Reproducibility (precision) in alternate site testing. A clinician’s perspective. Arch Pathol
Lab Med 1995; 119:914-7.
3. Neuberger J, Peters M. The clinical interface - a British physician’s view. Clin Chim Acta 1996;
248:11-8.
4. Howanitz JH, Howanitz PJ. Laboratory results. Timeliness as a quality attribute and strategy. Am J
Clin Pathol 2001; 116:311-5.
5. Plebani M, Wu A. Foreward. Clin Chim Acta 2004; 346:1-2
6. Handorf CR. College of American Pathologists Conference XXVIII on alternate site testing:
introduction. Arch Pathol Lab Med 1995; 119:867-73.
7. Howanitz PJ, Steindel SJ. Intralaboratory performance and laboratorians’ expectations for stat
turnaround times. A College of American Pathologists Q-Probes study of four cerebrospinal fluid
determinations. Arch Pathol Lab Med 1991; 115:977-83.
8. Steindel SJ, Howanitz PJ. Physician satisfaction and emergency department laboratory test
turnaround time. Arch Pathol Lab Med 2001; 125:863-71
9. Hilborne LH, Oye RK, McArdle JE, Repinski JA, Rodgerson DO. Evaluation of stat and routine
turnaround times as a component of laboratory quality. Am J Clin Pathol 1989; 91:331-5.
10. Steindel SJ, Howanitz PJ. Changes in emergency department turnaround time performance from
1990 to 1993. A comparison of two College of American Pathologists Q-probes studies. Arch Pathol
Lab Med 1997; 121:1031-41.
11. Lundberg GD. Acting on significant laboratory results. JAMA 1981; 245:1762-3.
12. Crook MA. Near patient testing and pathology in the new millennium. J Clin Pathol 2000; 53:27-
30.
45. 45
13. Fermann GJ, Suyama J. Point of care testing in the emergency department. J Emerg Med 2002;
22:393- 404.
14. Seamonds B. Medical, economic, and regulatory factors affecting point-of-care testing. A report
of the conference on factors affecting point-of-care testing, Philadelphia, PA 6-7 May 1994. Clin Chim
Acta 1996; 249:1-19.
15. Hicks JM, Haeckel R, Price CP, Lewandrowski K, Wu AH. Recommendations and opinions for
the use of point of-care testing for hospitals and primary care: summary of a 1999 symposium. Clin
Chim Acta 2001; 303:1-17.
16. Saxena S, Wong ET. Does the emergency department need a dedicated stat laboratory? Continuous
quality improvement as a management tool for the clinical laboratory. Am J Clin Pathol 1993;
100:606-10.
17. Manor PG. Turnaround times in the laboratory: a review of the literature. Clin Lab Sci 1999; 12:85-
9.
18. Rollo JL, Fauser BA. Computers in total quality management. Statistical process control to
expedite stats. Arch Pathol Lab Med 1993; 117:900-5.
19. Valenstein P. Turnaround time. Can we satisfy clinicians’ demands for faster service? Should we
try? Am J Clin Pathol 1989; 92:705-6.
20. Truchaud A, Le Neel T, Brochard H, Malvaux S, Moyon M, Cazaubiel M. New tools for laboratory
design and management. Clin Chem 1997; 43:1709-15.
21. Howanitz PJ, Cembrowski GS, Steindel SJ, Long TA. Physician goals and laboratory test
turnaround times. A College of American Pathologists Q-Probes study of 2763 clinicians and 722
institutions. Arch Pathol Lab Med 1993; 117:22-8.
22. Valenstein PN, Emancipator K. Sensitivity, specificity, and reproducibility of four measures of
laboratory turnaround time. Am J Clin Pathol 1989; 91:452-7.
23. Holland LL, Smith LL, Blick KE. Reducing laboratory turnaround time outliers can reduce
emergency department patient length of stay: an 11-hospital study. Am J Clin Pathol 2005; 124:672-
4.
24. Steindel SJ, Novis DA. Using outlier events to monitor test turnaround time. Arch Pathol Lab Med
1999; 123:607-14.
46. 46
25. Vollmer RT. Analysis of turnaround times in pathology: an approach using failure time analysis.
Am J Clin Pathol 2006; 126:215-20.
26. Howanitz PJ. Errors in laboratory medicine: practical Laboratory Turnaround Time 192 I Clin
Biochem Rev Vol 28 November 2007 lessons to improve patient safety. Arch Pathol Lab Med 2005;
129:1252-61.
