Targeted changes to endoscopy workflow—particularly in scheduling and patient intake—can yield both operational and patient benefits, according to two separate quality improvement projects presented at DDW 2025. The research, conducted by staff at Mayo Clinic, in Rochester, Minnesota, underscores a growing emphasis on optimizing outpatient procedure operations amid staff shortages, rising procedural volumes, and growing patient expectations, with even modest time savings translating into meaningful improvements in patient satisfaction and system efficiency.
Smarter Scheduling, Smoother Flow
One initiative addressed operational inefficiencies in the outpatient endoscopy unit, including bottlenecks in patient flow, particularly between 7 and 9:30 a.m., and inconsistent staff utilization (poster Su1150). According to the investigators, patients often were scheduled to arrive earlier than needed, resulting in backups and excessive wait times in the lobby, changing area, and procedural unit, followed by idle time for staff later in the day.
The research team analyzed patient time spent in the unit over a year and found that patients averaged 163 minutes from check-in to checkout, including an average of 11 minutes in the lobby and 61 minutes in the pre-procedure waiting area. In addition, patient experience scores related to visit flow, delays, and wait times were below the 60th percentile, they reported.
The team redesigned scheduling templates to better reflect anticipated procedure durations and room turnover times. Using average case lengths, they worked backward to determine more balanced patient arrival times that would allow for smoother transitions through intake, preparation, and the procedure itself.
The new scheduling approach limited arrivals to no more than five patients within a 30-minute window. As a result, average patient time on the unit (not including lobby time) decreased by 14 minutes, from 163 to 149 minutes, with the average time going from 11 to 9.5 minutes in the lobby and 61 to 46 minutes in the pre-procedure area.
“It was about being strategic with our patients,” said poster presenter Julie Armenta, MSN, RN. “There is no need for them to arrive extra early for these procedures without a valid reason.”
These operational improvements also allowed for a reduction in pre-procedural intake nursing full-time equivalents (FTEs) from seven to six, and patient experience scores improved by 10 points in categories such as visit flow and wait time.
“It is spectacular to see that even small-time gains appear to have resulted in major improvements in patient satisfaction,” said Vivek Kaul, MD, a professor of medicine and former division chief of gastroenterology and hepatology at the University of Rochester Medical Center, in New York, who was not involved in these projects. “That is the power of process improvement, when it is done right. Remember that even small-time gains will add up cumulatively when collated across a busy practice or health system over time.”
Online Intake Helps Streamline Communication
In a separate initiative, Mayo researchers focused on improving efficiency through a virtual intake project designed to reduce time spent on information exchange during the intake process (poster Su1254).
The project introduced an Endoscopy Readiness Guide (ERG), which was delivered to patients through the online patient portal up to seven days before their procedure. The ERG included questions about recent medical changes, implanted devices, and understanding of bowel prep and fasting.
On the day of the procedure, patients received an Endoscopy Readiness Checklist (ERC), covering final intake details such as prep adequacy and post-procedure transportation plans. This information automatically populated nurse flowsheets for easy review.
“Before we knew this was a solution, we knew that there were bottlenecks to the practice,” study presenter Miranda Hamlin, MA, told GEN Priority Report. “We were trying to improve that efficiency of the unit as well as better utilization of our RN time, allowing our RNs to work at the top of their licensure.”
Over the first three months following implementation, intake time dropped by three minutes. Statistical projections suggest that with additional refinements, intake time could be reduced by 20 minutes for 80% of patients, saving an average of seven minutes and 43 seconds per patient. Nurse intake workload also was reduced by 1.14 FTEs for daily volumes of 70 to 100 patients. Patient preparedness improved as well, with those reporting the highest level of preparedness rising from 67% to 78%.
“These interventions should be reproducible across health systems with similar platforms, operations, and resources,” Dr. Kaul said. “The overarching unmet needs of patients and providers do not differ significantly from place to place. I look forward to multicenter initiatives to validate these data and help establish new practice operations paradigms for all of us.”
Dr. Kaul said he believes these efforts strike at the heart of modern endoscopy challenges. “This is a critically important issue that has a huge impact in clinical practice at every level of patient and provider experience,” he said. “Identifying gaps, such as the Mayo group has done, using readily available patient readiness tools and streamlining the patient journey should bear similarly positive results for most practices.”
While distinct in their interventions, both projects share a common theme: Operational tweaks at the clinic level can yield significant improvements in the patient experience. By identifying specific friction points in scheduling and intake, the results suggest that improving efficiency doesn’t always require massive overhauls but rather focused, data-driven adjustments.
“Process improvement isn’t just about time—it’s about creating a more predictable, patient-centered experience,” Dr. Kaul noted. “These results show that even modest adjustments can have significant, positive ripple effects for the practice and the patient journey.”
—Meg Barbor, MPH
Ms. Armenta, Ms. Hamlin, and Dr. Kaul reported no relevant financial disclosures. Dr. Kaul is a member of the Gastroenterology & Endoscopy News editorial board.
This article is from the December 2025 Priority Report print issue.