Gastroenterological Endoscopy. Группа авторов
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Название: Gastroenterological Endoscopy

Автор: Группа авторов

Издательство: Ingram

Жанр: Медицина

Серия:

isbn: 9783131470133

isbn:

СКАЧАТЬ How can the time and efficiency of physicians be optimized?

      d) How can the endoscopic equipment be used most effectively?

      e) How and when is the endoscopic report generated and given/explained to the patient?

      4. Which reprocessing concept is planned?

      a) Processing of endoscopes within the unit or in central facility?

      b) Reprocessing of material or exclusive single use?

      c) What concept of reprocessing the endoscopes is carried out (separation of unclean and clean area), and what type of reprocessing machines will be used?

      d) What room concept (ceiling supplies or trollies) is planned?

      5. How is sedation performed in the endoscopic suite?

      a) Percentage of procedures with sedation.

      b) What type of sedation is used and what is the process for patient monitoring during and after the procedure?

      c) Need for and frequency of general anesthesia.

      d) How is general anesthesia performed?

      e) Does the endoscopy suite provide care to children of all ages?

      5.3 Guidelines for Planning an Endoscopy Suite

      The space concept of an endoscopic suite is influenced by many factors. If the endoscopy suite is planned de novo or in a new building, an ideal room concept can be realized. However, if the unit is built into an existing building, there is always a compromise between demands and technical feasibility. The number of endoscopy rooms within the endoscopy suite depends on several factors such as the estimated number of endoscopic procedures and the breakdown by type, complexity, and need for fluoroscopy or radiography. Precise updated numbers and a development plan for the upcoming years should be made available for planning, as these statistics are often outdated.1

      Furthermore, transport and waiting times as well as the management of patients outside of the procedure rooms are relevant. A clearly defined and structured monitoring of sedated patients is mandatory, and sufficient space, monitors, and staff personal for this need to be considered. Some units have individual pre-procedural rooms for each patient, to assess, undress, recover, dress, and review patients before discharge. In some countries, the requirements for the postprocedural recovery are clearly regulated and need to be considered before planning.2 When there is limited recovery space and when more than one patient shares a room, there should be one or two interview rooms available for postprocedure consultation (

Fig. 5.1,
Fig. 5.2).

      5.4 Pathways for Patients, Staff, and Material

      When planning a new unit, it is advisable to first plan the pathways of individual patient populations (inpatients, outpatients), endoscopes, doctors, and nursing staff. Questions to be addressed include: where does the patient (outpatient or bedbound) enter the endoscopy unit, where do the preparation, undressing, and preprocedural assessment take place, and how and where does the patient leave the unit. If possible, preparation and recovery of the patients should be carried out independently of the procedure rooms, as this increases flexibility and productivity of the unit. On the other hand, separated recovery areas require additional staff and space. Furthermore, it is advisable to separate patients waiting for procedures from those recovering. Additionally, the number and timing of outpatient procedures performed without sedation have to be estimated, as these patients require less infrastructure and nearby changing rooms eventually with direct access to the procedure room.

      Fig. 5.1 Example of a concept of an endoscopy unit with adjacent daycare unit. It is important to visualize pathways of patents, doctors, and staff for optimizing work flow.

      Fig. 5.2 Concept of the endoscopic suite in more detail consisting of procedure rooms (red), area for cleaning and processing of endoscopes (green), area for staff base, and changing of staff personnel (blue).

      For the endoscopists, it is important to define the endoscopic workflow beforehand. Who performs sedation (specialized staff, Nurse Administered Propofol Sedation [NAPS] nurses, anesthetist, second physician)? When and how is the procedure report created? Will there be a report given to the patient prior to leaving the unit, or will it be finalized after the patient leaves? According to the answers, the pathways (computer-based report generation location, printout, and signature) have to be developed. Similar pathways should be defined for equipment and material including endoscopes and working/break areas for the endoscopy staff. A close proximity between procedure rooms and cleaning and disinfection area is desirable. In this context, it is important to define how the contaminated endoscopes are transported back to the unclean area of the cleaning facilities and how the cleaned endoscopes are transported back into the procedure room. In many modern endoscopy units, a special closed trolley system is used for this purpose.

      5.5 Location of the Unit

      The strategic location of the unit is crucial and should be based on the number of inpatient and/or outpatient procedures. If the majority of endoscopic examinations are outpatient procedures, a location next to the outpatient department or day care unit is desirable (

Fig. 5.1,
Fig. 5.2), unless daycare facilities are fully provided for within the unit itself.1,3 At many units, the majority of patients are ambulatory, with a significant minority arriving in wheelchairs or trolleys, or even on hospital beds. A suitable reception area is needed, as well as an area for patients to await endoscopy on trolleys, on which they will be transported directly into the endoscopy room. Changing facilities in or near this waiting area must be provided. The waiting area can also serve as the recovery area to which patients are returned after endoscopy, though it is advisable to have separate waiting and recovery areas. Waiting and recovery areas must also be provided with toilet facilities. After full recovery, ambulatory patients should await discharge in the reception area, which can also be occupied by relatives and friends. Waiting-room space can be calculated on the basis of eight chairs for each endoscopy procedure room. This is based on two or three seats for the waiting patient and family members, and two each for family members of the two patients in recovery and the patient undergoing the procedure.

      If outpatients and inpatients are treated, then simultaneous but separate patient flow pathways should be created (

Fig. СКАЧАТЬ