A simulation study to reduce nurse overtime and improve patient flow time at a hospital endoscopy unit

Increasing demand for endoscopic procedures, coupled with decreasing insurance reimbursement, has necessitated improvement in endoscopy unit operational performance measures, such as increasing throughput and reducing staff overtime without an increase in patient waiting time. In pursuit of improving these measurements, maintaining the nurse-to-patient ratio requirements in the recovery area throughout the clinic's operation time is a challenging problem for endoscopy units. To maintain compliance with this ratio, patients occasionally have to be held in the procedure rooms during the clinic's peak time. On the other hand, level loading could potentially increase the amount of overtime. In this paper, we describe our efforts to use discrete event simulation to investigate the impact of several strategies to address the minimum recovery nurse requirements in the endoscopy unit of Duke University Medical Center. Our objective was to minimize patient flow times and nurse overtime while sustaining the required nurse-patient staffing ratio in recovery.