Projected Impact of COVID-19 on Workflow, Cost of Ambulatory Endoscopic Centers

covid19, patient screening
Investigators examined the projected impact of coronavirus disease 2019 (COVID-19) screening on the productivity and workflow of ambulatory endoscopy centers.

Investigators examined the projected impact of coronavirus disease 2019 (COVID-19) screening on the productivity and workflow of ambulatory endoscopy centers. Results were published in Gastrointestinal Endoscopy. According to a discrete event simulation model, COVID-19 testing will adversely affect patient wait time, total facility use time, and cost per case. The investigators emphasized the need for increased facility reimbursement as endoscopy centers reopen during the pandemic.

The investigators developed a discrete event simulation-based model to assess the impact of COVID-19 on the workflow of ambulatory endoscopy centers (AECs). The model was constructed using workflow data from a community-based, 2-room, single-specialty clinic performing approximately 6000 endoscopic procedures per year. The clinic was observed for staffing patterns and number of daily COVID-19 cases over the final 2 quarters of 2019. Long-term changes to AEC workflow due to COVID-19 were modeled using 2020 recommendations from the American College of Gastroenterology. According to these recommendations, all patients scheduled for endoscopic procedures must undergo same-day molecular testing and temperature, symptom, and exposure screening. Only screened patients are to be granted access to the waiting room. A Monte Carlo simulation with 1000 iterations was performed to assess the impact of these COVID-19-related recommendations on productivity and workflow.

COVID-19-related modifications resulted in significant increases in total case processing time and patient wait time. A bottleneck effect was observed with pre-procedural COVID-19 screening. Investigators observed consequent decreases in productivity and financial metrics. In models that used only 1 triage technician to perform COVID-19 testing, total facility use time per case doubled. Additionally, cost-per-case increased 42% to accommodate overtime payment for staff. With 2 COVID-19 screening technicians, testing was more efficient and cost-effective. However, late discharge and increased hours of operation were observed with any COVID-19 testing arrangement. Increasing overtime pay to maintain baseline case load was more cost-effective than decreasing the number of cases per day.

Results from this discrete event simulation model emphasize the difficulties of maintaining ambulatory clinic workflow during the COVID-19 pandemic. Utilization of more COVID-19 testing technicians is likely a more cost-effective and time-saving option. Even so, COVID-19 testing required staff to work overtime and patients to wait longer.

As a study limitation, Dr Das noted that patient satisfaction was not measured. Patient satisfaction is likely a significant component to maintaining AEC workflow: patients unhappy with pre-procedural screening may be more likely to cancel appointments. Results may also not be generalizable to larger, multi-specialty clinics.

Even so, simulation data suggest that COVID-19 will significantly impact the workflow and financial metrics of AECs. “These results call for urgent action by governmental and commercial payors to adjust facility reimbursement fees for endoscopic procedures done in AECs to keep them open and financially viable in the post-COVID -19 era,” Dr Das wrote.  

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Das A. Impact of the COVID-19 pandemic on the workflow of an ambulatory endoscopy center: an assessment by discrete event simulation [published online June 10, 2020]. Gastrointest Endosc. doi: 10.1016/j.gie.2020.06.008