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Efficiency of Performing Pulmonary Procedures in a Shared Endoscopy Unit: Procedure Time, Turnaround Time, Delays, and Procedure Waiting Time

Verma, Akash MD, MRCP; Lee, Mui Yok BSc; Wang, Chunhong BSc; Hussein, Nurmalah B.M. BSc; Selvi, Kalai BSc; Tee, Augustine FCCP

Journal of Bronchology & Interventional Pulmonology: April 2014 - Volume 21 - Issue 2 - p 135–141
doi: 10.1097/LBR.0000000000000050
Original Investigations

Background: The purpose of this study was to assess the efficiency of performing pulmonary procedures in the endoscopy unit in a large teaching hospital.

Methods: A prospective study from May 20 to July 19, 2013, was designed. The main outcome measures were procedure delays and their reasons, duration of procedural steps starting from patient's arrival to endoscopy unit, turnaround time, total case durations, and procedure wait time.

Results: A total of 65 procedures were observed. The most common procedure was BAL (61%) followed by TBLB (31%). Overall procedures for 35 (53.8%) of 65 patients were delayed by ≥30 minutes, 21/35 (60%) because of “spillover” of the gastrointestinal and surgical cases into the time block of pulmonary procedure. Time elapsed between end of pulmonary procedure and start of the next procedure was ≥30 minutes in 8/51 (16%) of cases. In 18/51 (35%) patients there was no next case in the room after completion of the pulmonary procedure. The average idle time of the room after the end of pulmonary procedure and start of next case or end of shift at 5:00 PM if no next case was 58±53 minutes. In 17/51 (33%) patients the room’s idle time was >60 minutes. A total of 52.3% of patients had the wait time >2 days and 11% had it ≥6 days, reason in 15/21 (71%) being unavailability of the slot.

Conclusions: Most pulmonary procedures were delayed due to spillover of the gastrointestinal and surgical cases into the block time allocated to pulmonary procedures. The most common reason for difficulty encountered in scheduling the pulmonary procedure was slot unavailability. This caused increased procedure waiting time. The strategies to reduce procedure delays and turnaround times, along with improved scheduling methods, may have a favorable impact on the volume of procedures performed in the unit thereby optimizing the existing resources.

Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore

A.V., M.Y.L., C.W., N.B.M.H., and K.S. participated in the coordination and collection of data. A.T. participated in the study design and performed critical review. A.V. conceived the study and participated in the study design, coordinated the collection of data, participated in data analysis, data interpretation, and helped to draft the manuscript.

The current study did not receive any funding from NIH, Wellcome Trust, HHMI, or other organizations.

Disclosure: There is no conflict of interest or other disclosures.

Reprints: Akash Verma, MD, MRCP, Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889 (e-mail:

Received August 10, 2013

Accepted February 4, 2014

© 2014 by Lippincott Williams & Wilkins.