Efficiency in endoscopic practice is more than just throughput—it’s about delivering safe, timely, and patient-centered care while maintaining the well-being of the healthcare team. Whether in an Ambulatory Surgery Center (ASC) or a hospital-based endoscopy unit, every member of the GI team has felt the pressure to “do more with less.” Yet each setting faces distinct challenges that shape how efficiency can—and should—be pursued. By comparing common pain points, we can uncover practical strategies that transcend environments.
1. Scheduling Complexity and Case Prioritization
Few aspects of endoscopy have as much impact on efficiency as scheduling. In ASCs, schedules are often designed for predictability and high-volume throughput. Case start times are tightly sequenced, and delays ripple through the entire day. Overbooked schedules or last-minute add-on cases can lead to rushed turnovers and staff fatigue. Anesthesia requirements in the ASC are typically more standardized and predictable, with consistent teams and protocols that help maintain a steady workflow.
In hospital units, unpredictability is the norm. Emergencies and urgent cases frequently displace elective procedures. Many hospital endoscopy suites are also shared spaces used by non-gastroenterology specialists, such as pulmonologists. These mixed-use settings introduce additional complexity, as various procedures can alter room setup, staffing, and equipment availability. Anesthesia coverage in hospitals may be more variable, especially when providers are shared with other procedural areas, leading to delays if schedules conflict or staffing is stretched thin. In some circumstances, workflows led by non-gastroenterologists may have different efficiencies compared to dedicated GI teams, which can affect scheduling predictability. While these units benefit from broader resources, complex procedures can create competition for room time alongside routine endoscopies.
Practical Tips:
- Consider creating clear protocols for case bumping and protected blocks for longer procedures.
- Build realistic buffers between cases to absorb variability.
- Factor in variability in procedure length among different endoscopists and non-GI specialties when forecasting room utilization.
- Use scheduling software that integrates with pre-op readiness checklists to prevent preventable delays
- Consider developing and promoting AI-based software to analyze how different combinations of endoscopist, nurse, technician, and anesthesia provider impact turnover rates.
2. Patient Preparation and Arrival Readiness
Patients who are not fully prepared on arrival can derail even the most efficient schedule. In ASCs, this often takes the form of NPO violations—patients forgetting fasting instructions—or arriving without a responsible adult to drive them home. The result is same-day cancellations or prolonged delays as staff scramble to accommodate the patients.
Hospitals face different obstacles: inpatients may arrive from their rooms inadequately prepped, with labs pending, or still consuming clear liquids. Transport delays from nursing units or procedural holds due to incomplete consults can create idle time for the endoscopy team. In both settings, it is also increasingly important to ensure adherence to local guidelines regarding the pre-procedure management of medications that could conflict with anesthesiology guidance or impact sedation safety, as omissions can lead to last-minute rescheduling or additional risk.
Practical Tips:
- Use pre-procedure calls 24–48 hours prior to confirm fasting status, transportation arrangements, and medication instructions, regardless of setting.
- Implement pre-procedure checklists in the electronic medical record and coordinate with nursing units to verify readiness before transport.
- In the hospital setting, consider assigning a dedicated transporter or transport team for endoscopy to reduce delays moving patients from their rooms to the procedure area.
- Assign a staff member to oversee readiness communication so issues can be resolved proactively.
- Ensure clear protocols and patient education regarding pre-procedure management of medications that may impact sedation safety.
3. Room Turnover and Equipment Availability
The transition between cases—often dismissed as a “routine” part of the day—is one of the most critical efficiency drivers. In ASCs, smaller teams can be more nimble, with clearly defined turnover workflows. But any lapse in accountability can lead to missing supplies, incomplete room setup, or delayed reprocessing of scopes. Because there is less redundancy, if a step is skipped, turnover stalls.
Hospital units face their own hurdles. Environmental services teams may be shared with other procedural areas, slowing room cleaning. Reprocessing can be delayed if endoscopes are sent to central sterile departments located far from the endoscopy suite. Equipment may be shared with the operating room, requiring advance planning to ensure availability.
Practical Tips:
- Develop standardized turnover checklists posted in each room.
- Empower a “room turnover lead” per shift to maintain accountability.
- Maintain a buffer inventory of essential accessories to avoid last-minute supply hunts.
4. Staffing Consistency and Training
Efficient endoscopy relies on teams who know the workflow, anticipate needs, and communicate seamlessly. In ASCs, staff are typically consistent and cross-trained, which fosters strong collaboration and predictability. However, small teams are highly vulnerable to absences—if one staff member calls out, coverage gaps can slow the day considerably.
Hospitals often have larger pools of rotating staff, many of whom float from other units. While this provides flexibility, it can create variability in experience and ownership of endoscopy-specific processes. New or infrequently assigned team members may not be familiar with the nuances of turnover, scope handling, specimen processing or sedation protocols, leading to delays.
Practical Tips:
- Develop onboarding checklists and “tip sheets” for float staff to accelerate orientation.
- Where possible, create dedicated core teams for endoscopy who can anchor the workflow.
- Incorporate simulation or in-service training for less frequent team members to build comfort with equipment and processes.
5. Institutional and Regulatory Barriers
External requirements are often invisible but powerful contributors to inefficiency. Both hospitals and ASCs are subject to an expanding array of accreditation standards, regulatory mandates, and documentation expectations. While these requirements are technically necessary for participation and reimbursement, many of them add little to no measurable value to patient care. In practice, they often function as administrative hurdles that siphon time and attention away from clinical work.
The burden of compliance—frequent audits, duplicative forms, and ever-changing policies—can overwhelm staff and stall process improvements. Hospitals, in particular, contend with additional layers of bureaucracy—committees, approvals, and budget cycles—that make even the most straightforward operational upgrades painfully slow. Simple changes, such as introducing a new scope cart or implementing a room turnover checklist, can trigger months of deliberation and red tape.
For teams already stretched thin, these demands can feel disconnected from the realities of endoscopy practice and contribute directly to burnout and disengagement.
Practical Tips:
- Map out regulatory and institutional requirements and integrate them into daily workflows wherever possible to avoid extra steps.
- Use shared electronic templates to reduce duplicative documentation.
- When proposing workflow improvements, build a clear business case that ties efficiency gains to institutional priorities such as patient satisfaction, risk mitigation, and throughput.
What Each Setting Can Learn from the Other
ASCs excel in standardization, tight accountability, and predictable patient flow. Hospitals bring strength in managing complexity, triaging emergent needs, and leveraging broader resources. By cross-pollinating ideas, each environment can find ways to elevate performance:
- Hospitals can borrow from ASC models of standard turnover checklists.
- ASCs can adapt elements of hospital triage protocols to prepare for unexpected disruptions.
- Both can benefit from robust pre-procedure readiness processes and continuous measurement of key metrics like first-case on-time starts and room turnover duration.
Conclusion
Efficiency is not about working faster at the expense of quality—it is about reducing friction so clinicians can focus on what matters: safe, compassionate patient care. By understanding and addressing the unique challenges in both ASCs and hospitals, GI teams can design workflows that are both resilient and sustainable.
Endoscopy will never be perfectly predictable, but with intentional process design, clear communication, and shared ownership, any practice can make meaningful strides in efficiency. In the end, the most important metric is not just cases completed per day, but the satisfaction and safety of the patients who entrust us with their care.
Mankanwal Sachdev, MD, FASGE, is a practicing gastroenterologist at the Arizona Centers for Digestive Health. Dr. Sachdev is a member of the ASGE Quality Assurance in Endoscopy Committee.