What Lessons (Including Cost Savings) We’re Learning from Standardizing Our Endoscopy Program

Less than a year into his task of standardizing endoscopy efforts throughout the Cleveland Clinic enterprise, John Vargo, MD, MPH, is caught in a whirlwind. After having visited 10 locations in 10 months, he was looking forward to relaxing over the holidays.

“I think I’m going to leave my cell phone in my office for a week, so I can enjoy my family in peace and quiet,” he joshed.

Exhausted but energized, the respected endoscopist calls his new project “rewarding and a lot of fun.”

“It is the right thing for our patients,” he says. “Our goal is to provide every endoscopy patient with the best care for the best value in a safe, comfortable environment. No matter where in the enterprise an endoscopy is done, the equipment, training and reprocessing will be the same.”

How do you eat an elephant?

Every year, Digestive Disease & Surgery Institute staff physicians perform 85,000 endoscopy procedures in 22 Cleveland Clinic hospitals, ambulatory surgery centers and endoscopy centers worldwide. Although outcomes have been very good, institute Chair Conor Delaney, MD, PhD, and Department of Gastroenterology, Hepatology and Nutrition Chair Miguel Regueiro, MD, felt the time was right to standardize endoscopy procedures enterprise-wide. Their goals were to augment and ensure quality, while minimizing waste and lowering the cost of procedures.

They tapped Dr. Vargo for this important job, knowing his combination of endoscopic and administrative experience with patient advocacy made him the ideal candidate.

One bite at a time

After gathering all stakeholders to identify what needed to be done, Dr. Vargo established committees with enterprise-wide oversight to carry out the tasks. To date, these have included:

• An Equipment Evaluation Committee, which meets weekly to review requests for new equipment and determine if and how that equipment would complement patient care.
• A Reprocessing Committee, which ensures standards for endoscope reprocessing are maintained throughout the enterprise. “We developed a software program to predict the lifespan of scopes, which helps enormously with this effort,” says Dr. Vargo. “This allows us to plan for capital investment in endoscopes. Additionally, having an enterprise wide inventory of our equipment allows us to strategically shift equipment from one site to another if the need arises, thereby avoiding the cost involved in purchasing additional equipment.”
• A Practice Development Committee, which critically addresses new technologies and procedures. The committee determines the need of a procedure for patient care, ensures that proper training occurs and helps determine where the services will be performed and the eventual scalability of the procedure to other sites.

It takes a village

In an innovative approach to resource stewardship, Cleveland Clinic pulmonologists and otolaryngologists were invited to join GI endoscopists on an Endoscopic Capital Communications Committee. While these like-minded practices use different scopes, all need cleaning, maintenance and periodic replacement.

“We share how we approach our inventories, strategize how best to deploy our equipment enterprise-wide and establish best practices to implement. This has helped us not only to understand our immediate capital needs, but in the budgeting process for two to five years down the road,” he says.

Progress happens quickly

“The concept of an endoscopic operations team may seem foreign, but it has paid dividends in patient care, cost minimization and value optimization from patient and system perspectives.

“The bottom line is that when different locations with endoscopic practices get together and talk, they can solve major problems, standardize procedures and learn from best practices,” says Dr. Vargo.