Free standing endoscopy clinics

[ghostcat]

One of our doctors is looking into starting a freestanding endoscopy clinic and has approached me to manage it. I currently work with him in a hospital based outpatient GI unit. I have alot of questions about how to staff for the best care and patient flow, as well as how to keep the patients moving through safely, but also efficiently. This is in Canada, so I am especially interested if anyone has experience with doing this in Canada. We are looking at having 2 procedure rooms with a mix of doctors using the space.

Some specific questions I have thought of:

Do you have all RNs or a mix of RN and LPN? How many staff member?

Do you admit patients in chairs, then walk to procedure room? If so, how do you get them to recovery area? (The hospital where I currently work admits pts on stretchers and they stay on it until they are discharged.

How many scopes per room are typically done in a day?

Who does your processing?

Thanks all!

[dishes, BSN, RN]

In Ontario, many healthcare providers and patients think the Rudd clinic provides excellent care. Maybe you could contact one of the clinic managers for answers to your questions.

http://www.ruddclinic.com/

regards

dishes

[whitesherlly05]

I dont live in Canada however, I'ev been a colon and rectal surgeon nurse for over 15 years. To answer your first question: Pending on the patients flow you may only need 1 RN and 1 to 2 LPN's and Maybe an MA to help with paper work, transporting patients from one room to another, checking vitals etc. Now, i really dont understand what you mean about " admit patient in chair" If you are refering to triage then yes. if an IV is already placed on the patient prior to lying them on their left hand- side before an procedure, then yes, rolling them in a wheelchair or the actual op table would be appropriate. D/C the patient the same way the hospital does it. Answer your scope question: you should have at least 2 scopes per room so that when the doctor is done with one colonoscopy, a clean scope will be available immediatly while the other one is being sterilized. As for your last question, what do you mean by "who does your processing." That can mean a lot of things. Are you talking about labs/bx?

I hope this helped

[ghostcat]

Thanks! All this helps.

When I was asking about where you admit/discharge I was asking for a strictly space (square footage) reason. The hospital GI clinic where I currently work has only stretchers - we admit the patient into a stretcher, start their IV, roll them down the hall to the procedure room, do the procedure on the stretcher, wheel them back to where they started and discharge them from the stretcher after their recovery time is up (1 hour from sedation time). This takes up more room then chairs (even lounge chairs) would, but I can't visualize getting the patients to and from the procedure.

The processing question was in relation to cleaning the scopes - do the nurses do it, or do you have techs?

Thanks again!

[whitesherlly05]

The techs will do them. Good luck.

[wvgi]

There are several certification organizations out there for endoscopy clinics (ambulatory centers).

One of them is the AAAHC. They have a great web site that will describe them to you. They offer a book for purchase which has guidelines for policies and procedures, guideines for what is expected to have an accredited facility. Also, the ASGE has a guideline for endoscopy centers available on their website that tells about developing an endoscopy center.

Normally, there should be two admit rooms and two recovery rooms for every procedure room you have. Staffing will depend n the ASA levels of your patients. Most freestanding centers do only ASA 1-2. One RN with an LPN or tech to help for admit, one RN and an LPN or two RNs for recovery. One RN and a tech in the procedure room and a scope tech for reprocessing. Then you will need whatever business staff such as registration and billing, etc.

Where I have worked, all patients are admitted on a stretcer and taken to the room, procedure done, and taken to recovery all on the stretcher.

As far as number of scopes, the recommendation is that no scope should be used more than two or three times in one day for the life of the scope. I would recommend Three upper scopes and three lower scopes for each room to be built. That way you will have a scope just used, a scope being used and a scope ready for use. Processing may take longer than the procedure and you don't want to have to wait on scopes.

Also, type of anesthesia used will make a difference on the timing of the procedure and amount of time required for recovery.