Gastroenterological Endoscopy. Группа авторов

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      5.6 Number of Rooms

      In general, upper and lower gastrointestinal (GI) tract endoscopies are separated, and thus there is a minimum of two endoscopy rooms even for a small unit. For larger units, approximately one endoscopy room per 1,000 examinations (diagnostic and low-scale therapeutic) annually is a rough estimate for capacity planning. The British Society of Gastroenterology recommends a minimum of 2 + 1 endoscopy rooms for 3,000 endoscopies per year.^3,4

      In larger units, the concept should also include a radiography unit and a multipurpose room for various procedures such as laser therapy, EUS, and emergency cases.⁵ Providing care for emergency cases has to be standardized and separated into those suitable for the endoscopy unit and those who should be treated in the intensive care unit or operating room. If a high volume of emergency and unscheduled cases are seen, then it is important to have at least one additional room for flexibility without interrupting the routine scheduled endoscopic program.³

      When additional techniques such as video capsule endoscopy and functional GI tests (manometry, breath test, absorptive tests) are planned and performed by the same staff, additional rooms for these tests and for reviewing capsule endoscopy should be planned for. In larger units or specialized centers performing 6,000 procedures (the 4 + 2 room model), a dedicated room for EUS, laser therapy, and photodynamic therapy should also be present.^{6,7,8,9,10,11,12,13,14,15,16}

      Therapeutic endoscopic procedures are increasingly time-consuming and result in lower productivity per room. Such interventional techniques as ESD, POEM, and double-balloon enteroscopy, which have longer procedure times, should be taken into account for workflow. There are recent reviews and published overviews on the time demands of the various endoscopic procedures, which have been validated.^8,9,17

      The amount of teaching that takes place in the endoscopy unit also has considerable impact on procedure performance time and can amount to as much as an additional 30% of time per procedure.

      Furthermore, the concept of report generation has to be considered (see below). If the report is generated immediately after the procedure with a computer-based documentation system, the time can be utilized for patient and room turnover. Thus, a single endoscopist could continuously work in one room. However, often the concept of switching rooms between procedures is applied. This increases the productivity of the individual endoscopist, but report writing and documentation might be less accurate. Capacity planning is important, and all calculations for procedure room capacity have to incorporate a realistic period (e.g., 10–15minutes) for cleaning and setting up the room for the next procedure.^6-16 However, capacity and productivity planning is often greatly affected by local characteristics (waiting time, in-house transportation, recovery facilities). Room productivity is a valuable quality measure for organization of the unit. However, productivity of a procedure room is also influenced by the availability of instruments (endoscopes) and the cleaning preparation cycles.

      5.7 X-Ray Requirements

      Besides ERCP and percutaneous transhepatic procedures, which depend on optimal X-ray imaging, several therapeutic endoscopic interventions such as dilation, placement of stents and probes, and double-balloon enteroscopy require radiographic guidance. If a unit requires more than 200 to 500 radiographic examinations per year, then a dedicated radiography room is recommended. In this case, either the third room in the 2 + 1 model should have such facilities or it should be possible in a separate additional room. Sharing X-ray facilities with other departments is possible, but there is a considerable loss of effective procedure time. Interventional ERCP strongly depends on the technical demands and optimal conditions of the procedure room. Movement of the endoscopy equipment to radiology should be minimized, and precautions are needed that when the equipment is moved it does not adversely affect the safety and performance.

      In most modern hospitals, a picture archiving and central storage system (PACS) is available, which allows digital archiving and distribution of X-rays. As PACS provides digital X-rays, high-quality monitors are needed to display the digital pictures in the various procedure rooms.

      5.8 The Endoscopic Examination Room

      5.8.1 Size of the Rooms

      A continuous point of discussion is the minimum size of an endoscopic procedure room. A general or multipurpose endoscopy room, primarily intended for GI endoscopy, should have a floor surface area of not less than 30 m². For rooms with X-ray facilities, a minimum room size of 36 m² is recommended (

Fig. 5.3).¹⁷ The requirements of recommended procedure room size have changed over the last years. According to the British Society of Gastroenterology, from 1990 a room measuring 25 to 30 m² was considered adequate if there was sufficient storage space outside the room for endoscopes and additional equipment.⁴ The corresponding American recommendation was an area of approximately 6.25 × 4.75 m or 30 m² in size, as appropriate.⁷ In a 2015 consensus statement of the German digestive society, a minimum room size of 30 m² is recommended. For rooms with X-ray, the minimum size is 36 m².

      In addition to the size of the procedure room, other general requirements should be met. The width of the entrance and corridors should be sufficient to allow for the transportation of beds, stretchers, and wheelchairs. It must be possible to turn beds around in the corridor. The standard door width should be 1.28 m, and the opening should have sliding doors. An “engaged” or “in use” sign as well as signs for “Laser” or “X-ray” should be present on the entrance doors to endoscopy rooms, where appropriate. The floor material in the procedure room must be fluid resistant and easy to clean and must conform to anesthetic and high-frequency electrical requirements (e.g., nonconducting).

      Fig. 5.3 Concept of a procedure room in more detail. The ground floor size is 38.5 m². In addition to a ceiling supply unit with two monitor systems, fitted cupboards (right side), a computer documentation area (upper left corner), changing room (UK) and toilet (WC) are integrated.

      5.8.2 Equipment

      The endoscopy room should contain a mobile examination table with adjustable height and positioning, a desk and chair, radiography viewing space, a work surface with a sink and cupboards, and waste containers for the various types of waste. There should be facilities for proper hand disinfection and storage of protective clothing and equipment. Storage space for accessories should be available in the endoscopy room or in an adjacent storage area.¹⁴

      There should be fitted cupboards for endoscopes and ancillary equipment, and washing facilities for staff and equipment. The procedure rooms should be equipped with high-quality video screens for viewing digital images.

      It is essential to have piped oxygen gas and suction facilities as well as pressured air. Insufflation using CO₂ is becoming routine for interventional endoscopic procedures and is increasingly used also during routine endoscopy. Thus, CO₂ outlets positioned close СКАЧАТЬ