'Chaos scheduler' boosts endoscopy utilization

The demand for gastrointestinal (GI) endoscopic procedures is steadily rising, fueled by expanding procedural capabilities and updated screening guidelines. At the same time, practices are grappling with access to specialists, anticipated workforce shortages, and declining reimbursements from both commercial insurers and government payers. Together, these pressures underscore the need for more efficient scheduling within endoscopy units to accelerate patient access, reduce delays, and keep practices operating smoothly.

In a practice management review published in Clinical Gastroenterology & Hepatology, first author Joshua L. Hudson, MD, a gastroenterologist and Director of Clinical Operations in the Division of Gastroenterology & Hepatology at the University of North Carolina School of Medicine, and colleagues highlighted previously reported strategies for improving endoscopy scheduling and throughput, and shared their own experiences at UNC, a large tertiary-care academic medical center.

In their review, the authors noted that existing recommendations to optimize endoscopy unit performance in terms of scheduling are largely conceptual, with few studies reporting measurable outcomes. For example, a discrete-event simulation study at Zuckerberg San Francisco General Hospital demonstrated potential efficiency gains in the pre-procedure area and post-anesthesia care unit (PACU). Adding staff in the pre-procedure area increased procedural volume by 14.6 cases per week, while reducing PACU recovery times to 30 minutes could yield an additional 13.8 cases per week. “Taken together, these findings highlight the tension between theoretical modeling and real-world feasibility,” Dr. Hudson and colleagues wrote. “The literature on endoscopy unit optimization remains limited in scope, with relatively little reporting on actual implementation outcomes.”

To address these gaps, the authors shared their own experience improving pre-procedure workflows at UNC, highlighting practical ways to make targeted changes within the routine operations of an endoscopy unit.

Successful strategies include:

1. Standardized Protocols and Forms: The authors created a uniform anti-thrombotic form that provides guidance on commonly used anticoagulants and antiplatelet agents, including recommended hold ties, to facilitate consistent practice. Forms can be shared electronically or embedded in the electronic medical record using SmartPhrases, allowing referring providers to document relevant information efficiently.

2. Dedicated Antithrombotic Workflow: Patients on anticoagulants or antiplatelet therapy can be triaged into a dedicated queue managed by trained nurses who coordinate with the prescribing provider. Once the necessary documentation is received, patients can be transitioned to a “ready-to-schedule” queue, ensuring clarity and reducing delays.

3. Enhanced Patient Communication: Clear instructions regarding medication management can be provided through electronic messaging or patient portals, supporting adherence and improving patient safety.

Last-minute appointment cancellations are another common headache for endoscopy units. At UNC, an average of 12 endoscopic procedures per week were unfilled due to cancellations that occurred 1–3 days before the date of service, a term the authors referred to as the “chaos period.” To address this, the authors hired a dedicated “chaos scheduler” whose only responsibility is to reassign cancelled slots.

From the launch of the chaos scheduler model at UNC 89% of patients successfully completed procedures. Weekly, an average of 11.7 slots that would have remained vacant were filled, increasing utilization in ambulatory endoscopy units from 83–87% to consistently above 95%. In higher-complexity units, utilization improved from 88% to 92%. The authors estimate that over the course of a year, this approach could allow 550–600 more procedures to be completed without needing major new equipment or facilities.

“We were surprised by how much of an impact just one additional staff member on our scheduling team was able to have on the utilization rate at our endoscopy centers,” Dr. Hudson said in an interview with GI & Hepatology News. “Particularly at our high-volume, ASC-like unit, the addition of the ‘chaos scheduler’ significantly improved room utilization. While hiring a new staff member is an investment, this was and remains an investment that has paid dividends back to our practice and to patient access.”

At the same time, the authors introduced an automated reminder system using both phone calls and electronic messaging to reduce no-shows and same-day cancellations. “Prior studies in gastroenterology and other ambulatory specialties have shown that automated reminders can decrease no-show rates by 20–30%, while also improving patient adherence to pre-procedure instructions, such as bowel preparation,” they wrote.

In Dr. Hudson’s opinion, a key take-home message of the review “is to work closely with your endoscopy scheduling teams and listen to their input and feedback,” he said. “Much of the processes for our practice surrounding the chaos scheduler and scheduling standardization came from our scheduling team. Their ongoing leadership has been key to the success of these measures.”

The researchers reported having no financial disclosures.