Impact of the COVID-19 pandemic on the workflow of an ambulatory endoscopy center: an assessment by discrete event simulation.,Gastrointestinal Endoscopy

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Impact of the COVID-19 pandemic on the workflow of an ambulatory endoscopy center: an assessment by discrete event simulation.
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2020-06-10 , DOI: 10.1016/j.gie.2020.06.008
Ananya Das ₁

Affiliation

Background and Aims

As community-based ambulatory endoscopy centers (AECs) across the nation are trying to reopen and safely resume outpatient endoscopic procedures after the unprecedented lockdown related to the coronavirus disease 2019 (COVID-19) pandemic, guidelines recommend pretesting and screening for COVID-19 along with other mitigation measures for the safety of patients and staff. The impact of such changes in the workflow of AECs on throughput and other performance indicators is largely unknown, although a significant reduction in revenue stream is expected.

Methods

A discrete event simulation–based model was developed in the setting of a small to medium community-based single-specialty AEC to quantify the impact of COVID-19–related workflow changes on performance indicators and cost per case compared with the pre–COVID-19 baseline.

Results

In the simulation model, post–COVID-19 recommended workflow changes significantly impacted the operational and productivity metrics and, in turn, adversely affected financial metrics. Overall, there was a significant decrease in staff utilization and consequent increase in total facility time, waiting time for patients, and cost per case because of a bottleneck at the time of preprocedure COVID-19 screening and testing while practicing social distancing. Strategies to minimize this adverse impact on productivity were assessed.

Conclusions

Pretesting and screening for COVID-19 as recommended by current guidelines will significantly impact the productivity and revenue stream of AECs. Urgent measures by payors are needed to adjust the facility reimbursement of endoscopy centers to ensure successful reopening and ramping up outpatient endoscopy services in these facilities already hit hard by the pandemic.

中文翻译：

COVID-19大流行对门诊内窥镜中心工作流程的影响：通过离散事件模拟进行的评估。

背景和目标

在与冠状病毒病2019（COVID-19）大流行相关的空前封锁之后，全国各地基于社区的门诊内窥镜中心（AEC）试图重新开放并安全地恢复门诊内窥镜检查程序，指南建议对COVID-19进行预测试和筛查以及其他减轻患者和人员安全的缓解措施。尽管预计收入流将大大减少，但在很大程度上不知道AEC的工作流程中的此类更改对吞吐量和其他性能指标的影响。

方法

在中小型基于社区的单一专业AEC的背景下，开发了基于离散事件模拟的模型，以与COVID-pre-之前相比，量化COVID-19相关的工作流程变更对绩效指标和每箱成本的影响。 19基线。

结果

在模拟模型中，COVID-19之后建议的工作流程更改显着影响了运营和生产率指标，进而不利地影响了财务指标。总体而言，由于在进行社会疏离过程中进行术前COVID-19筛查和测试时出现了瓶颈，因此员工使用率显着下降，因此设施总时间，患者等待时间和每例成本增加。评估了将这种对生产率的不利影响降至最低的策略。