Irish Journal of Medical Science

, Volume 180, Issue 1, pp 143–148

Utilization of resource leveling to optimize ERCP efficiency

  • L. M. Hendrick
  • G. C. Harewood
  • S. E. Patchett
  • F. E. Murray
Original Article



Optimizing endoscopy efficiency is becoming increasingly important. This study profiled ERCP availability and assessed resource leveling as a strategy to enhance efficiency.


All ERCPs performed at an academic teaching hospital between January 2007 and December 2008 were reviewed. Procedure timeliness (time between admission and ERCP) and demand were analyzed to assess resource utilization.


Data were recorded for 393 ERCPs. Profiling identified an unequal distribution of waiting times from admission to procedure due to restricted ERCP availability. Use of resource leveling methodology demonstrated that a small increase in procedure availability (one additional half day per week) would significantly reduce the hospital stay of ERCP patients.


Resource leveling can be applied to balance procedure provision with demand to cope with fluctuations in demand. The impact of resource leveling can be truly measured only by implementing these changes and prospectively studying the effect.


Resource leveling Resource utilization ERCP Endoscopy efficiency Procedure timeliness Procedure demand Length of hospital stay 


  1. 1.
    Cohen S, Bacon B, Berlin J et al (2002) NIH State-of-the-Science statement on ERCP. Gastrointest Endosc 56(6):803–809CrossRefPubMedGoogle Scholar
  2. 2.
    Barrison IG, Bramble MG, Wilkinson M et al. (2001) Working Party Report on behalf of the Endoscopy Committee of the British Society of Gastroenterology: provision of endoscopy related services in district general hospitals. British Society of GastroenterologyGoogle Scholar
  3. 3.
    Sivak MV Jr (2002) Evidence-based endoscopy. Gastrointest Endosc 56(6):948–950CrossRefPubMedGoogle Scholar
  4. 4.
    Conti CR (2003) Restricted weekend services result in delays in discharges from hospital. Clin Cardiol 26:1CrossRefPubMedGoogle Scholar
  5. 5.
    Varnava AM, Sedgwick JE, Timmis AD et al (2002) Restricted weekend service inappropriately delays discharge after acute myocardial infarction. Heart 87:216–219CrossRefPubMedGoogle Scholar
  6. 6.
    Cram P, Hillis SL, Rosenthal GE et al (2004) Effects of weekend admission and hospital teaching status on in-hospital mortality. Am J Med 117:151–157CrossRefPubMedGoogle Scholar
  7. 7.
    Bell CM, Redelmeier DA (2001) Mortality among patients admitted to hospitals on weekends as compared to weekdays. N Engl J Med 345:663–668CrossRefPubMedGoogle Scholar
  8. 8.
    Brennan TA, Leape LL, Laird NM et al (1991) Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. N Engl J Med 324:370–376CrossRefPubMedGoogle Scholar
  9. 9.
    Davies AH, Ishaq S, Brind AM, Bowling TE, Green JR (2003) Availability of fully staffed GI endoscopy lists at the weekend for inpatients: does it make a difference? Clin Med 3:189–190PubMedGoogle Scholar
  10. 10.
    Lee LH, Swensen SJ, Wood DL et al (2005) Optimizing weekend availability for sophisticated tests and procedures in a large hospital. Am J Manag Care 11:553–558PubMedGoogle Scholar
  11. 11.
    Marcus SN (2006) Efficiency in endoscopy centers. Gastrointest Endosc 64:675–677CrossRefGoogle Scholar
  12. 12.
    Harewood GC, Chrysostomou K, Leong WL et al (2008) A “time-and-motion” study of endoscopic practice: strategies to enhance efficiency. Gastrointest Endosc 68(6):1043–1050CrossRefPubMedGoogle Scholar
  13. 13.
    Harewood GC, Ryan H, Patchett S et al (2009) Potential impact of enhanced practice efficiency on endoscopy waiting times. Ir J Med Sci 178(2):187–192CrossRefPubMedGoogle Scholar
  14. 14.
    Zamir S, Rex DK (2002) An initial investigation of efficiency in endoscopy delivery. Am J Gastroenterol 97(8):1968–1972CrossRefPubMedGoogle Scholar
  15. 15.
    Bell CM, Redelmeier DA (2004) Waiting for urgent procedures on the weekend among emergently hospitalized patients. Am J Med 117:175–181CrossRefPubMedGoogle Scholar
  16. 16.
    Siciliani L, Hurst J (2005) Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries. Health Policy 72:201–215CrossRefPubMedGoogle Scholar
  17. 17.
    Masursky D, Garver MP, Nussmeier NA et al (2009) Incentive payments to academic anesthesiologists for late afternoon work did not influence turnover times. Anesth Analg 108(5):1622–1626CrossRefPubMedGoogle Scholar
  18. 18.
    Kolker A (2009) Process modeling of ICU patient flow: effect of daily load leveling of elective surgeries on ICU diversion. J Med Syst 33(1):27–40CrossRefPubMedGoogle Scholar
  19. 19.
    Nasr A, Reichardt K, Walsh TN et al (2004) Impact of emergency admissions on elective surgical workload. Ir J Med Sci 173(3):133–135CrossRefPubMedGoogle Scholar
  20. 20.
    Levin SR, Dittus R, France D et al (2008) Optimizing cardiology capacity to reduce emergency department boarding: a systems engineering approach. Am Heart J 156(6):1202–1209CrossRefPubMedGoogle Scholar
  21. 21.
    Selker HP, Beshansky JR, Kassirer JP et al (1989) The epidemiology of delays in a teaching hospital. The development of a tool that detects unnecessary hospital days. Med Care 27:112–129CrossRefPubMedGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2010

Authors and Affiliations

  • L. M. Hendrick
    • 1
  • G. C. Harewood
    • 2
  • S. E. Patchett
    • 2
  • F. E. Murray
    • 2
  1. 1.University College Dublin School of MedicineDublinIreland
  2. 2.Department of Gastroenterology and HepatologyBeaumont HospitalDublinIreland

Personalised recommendations