So, as a reminder, the Q&A box is open for people to put in their comments, suggestions or questions. I think we have about 15 minutes or less to go. Eden, do you want to start us off? Sure. We have a question in about a culture of safety, and the person is curious about what processes in endoscopy processing, cleaning verification are occurring with patient safety in mind and not dumping on individuals. So we have a couple resources. When you go into your GILeap account, so remember, the recordings from this course are going to populate your GILeap account in about three to four weeks, but all the slide decks that you saw today are there. I'm going to add these cases, but if you log into GILeap, I have some additional resources in there. I've put a lot of different guidelines, and there's some guidelines in there that address reprocessing, and what ASG would say is think about which guidelines you've adopted. I hope this addresses your question, Randy, but think about which guidelines you have adopted. We have in there our multi-society reprocessing guideline. We also have a paper in there that compares reprocessing guidelines from ARN, SGNA, the multi-society reprocessing guideline, and the AMI standard. So we look at where there's similarities, where there is differences. The GI societies would point out that cleaning verification is not necessarily FDA approved, and if you do follow AMI's standard, FDA did a partial adoption of their standard. There were a few things they had on cleaning and drying verification. I think it was specifically drying verification in that case where they would not adopt those because they were not FDA approved. So we're going to refer you to those resources, but I also have documents in there on ADR, you know, our quality indicators for colonoscopy, so a lot of guidelines in there just all right in one module for you. So let me just go ahead and ask the next question, Dr. Eisenberg. I just wanted to kind of quickly point out those references first. Our next question is, as a director of endoscopy from GI where nursing and support staff are under surgical nursing department and anesthesia, also a separate entity, any tips to maximize efficiency and safety? All three are under separate management. Yeah, this is a very good question, Anusha. I think that when faced with situations like this, that's very similar to many institutions which have different silos for teams. It's actually important that the leadership for each of these teams meets with the others to go over what the overall team mission is for endoscopy and discuss some of the problems and challenges that are associated with having different reporting structures and different responsibilities. It almost requires kind of like the chief medical officer or department heads of hospitals who have these different silos to come together to discuss these issues and form a culture in which communication can occur without blame because there's always these instances where the endoscopist team feels that the limits imposed by the anesthesia team or the nursing team detract from providing quality care and or high safety standards for patients. It goes back to having those discussions at a high level so that discussions can occur at the lower end to serve the patients. It all comes down to how are we taking care of patients and that's what the focus should be. John, you may have had this situation. Nisa, I think as well, may have had these situations evolve. What are your thought processes about that question? Yeah, we're a large organization at the Minnesota site and we have three different endoscopy units. There's about 100 gastroenterologists and that's why. One of the units is an anesthesia run unit and so it's surgical services that basically owns that footprint. We occupy six rooms and interventional radiology occupies two of those rooms. All of our cases that are done on that particular unit are complex procedures. That's a perfect example where we are basically guests in somebody else's house. To some extent, we have to operate according to their rules. We can only push so hard when we know that the amount of time that's spent pre-opping a patient by an anesthesiologist is going to be longer than we're going to provide for a moderate sedation patient. Their standards that they have to adhere to are different. They can't have different standards in our unit compared to their standards in the OR, for example, for surgical services nurses. We have meetings on a joint basis, on a regular basis, and try to be transparent about what our respective limitations are and how much we can bend the rules and how much inconsistency we can introduce between our different units, if that makes sense. I'm happy to explain in further detail if anybody would like. I would echo what you guys said. It's communication, communication, communication. I have a standing meeting with nursing leadership and anesthesia leadership on a monthly basis. We bring actual objective data. We bring metrics to the table to say this is what led to a delay in room turnover. We know whether or not it was the anesthesia team. We know whether or not it was the prep team. So, using factual information always helps as opposed to anecdotal data. I can tell you I also have a great working relationship with my nursing leaders and my anesthesia leaders. We are on a text stream, and it's a very active text stream. And leadership level, I think, really does allow the right message to disseminate and trickle down to the endoscopy. So, Debbie, do you have some input about this? I know that you're mostly an outpatient center, but I'm assuming that you do have some similar issues that come up with silos, nursing, and anesthesia. Yeah, I would agree with all of your comments that this actually takes the entire spectrum of the teams to work together. I know we have a monthly directors meeting. So, we have a director of operations, the director of nursing. We have our finance. We have recently elected a medical director in anesthesia. And so, bringing information that is credible and factual as to room turnover time or delays in procedure for whatever reason or occurrence that may be, we actually keep track of those kinds of things. And then it's a discussion between those directors to say, how can we improve? And if this is one particular area, how can we help them improve? And then maybe it drills down to one particular person, that nurse that maybe has been there for 15 years, and she's slowed down. We maybe need to drill down to all those things. But I think it takes a collective team in order to put your heads together and come up with a plan to make it work. Excellent points. I hope that answers your question, Ndesha, about ways to strategize this cooperation to occur. Eden, I don't know, are there any more questions? I'd love to hear more questions if there are any. We don't have any more questions, and we only have three minutes. So I don't know if you want to try a case or if we will provide everybody with these case slides so that you can talk amongst them among your team. And we will strategize ways to follow up, because it feels like this four hours was just an amuse-bouche to a much bigger meal we need to have. Yes, I would agree with that. Maybe we can give a one-sentence answer to this case. I think everybody has been reading this case as the previous discussion was going on. So this is a very dissatisfied patient. And so what can be done? I'll ask John, since he's at the top of my speaker gallery, what one thing would he do? Yeah, these are always tough situations, I think. And service recovery is never fun. But I think being good at calming the situation down first and having a one-to-one talk with the individual, and diffusing the situation, and then offering some service recovery is the way to go. That's my one-sentence answer. OK, Nisa? Involve risk. Involve your entire service recovery team to help manage this individual. I agree, de-escalate the situation, but make sure you've got all the support personnel that you need to help manage this individual. Who would be the first person to contact this patient? At our institution, it would be risk. We have a risk management slash service coordination team. They're a combined unit. So it would be somebody from that unit. In reality, what would happen is our poor nurse manager would be the first person to call to the bedside to deal with the initial conversation. And then it would be escalated to the service recovery slash risk team. OK, and I'm assuming that this patient probably complained about his care after he had left because he doesn't remember anything when he got home. So, Debbie, any words of wisdom? Yeah, I think quicker and pay attention. As soon as you can get a hold of this patient, talk to them about their complaint. Admit any fault, if there is, on our part. And certainly reassure them that internally you're going to review the process, discuss everybody involved, and that you're trying to always improve our patient experience. We do have a patient experience team who kind of navigate through that as well. But unfortunately, it does start with my nurse managers. And then when it ends up with me, then we have a real problem at that point. So it's always that point where we're not making them happy again. So it's unfortunate. But yeah, I think definitely the quicker you can respond to that patient and try to diffuse the situation, the better off you are. Yeah, and I think this kind of illustrates that there are different types and quantity of resources available depending on where you are, whether you actually can involve a risk department, which I would assume is a little bit more challenging in the outpatient private practice world. But so I think we're coming to the end. And as I mentioned several times throughout this course, I've learned a lot from being part of this course. I hope you've all learned a lot as well. We tried to incorporate these case-based discussions in this format. And I hope you agree that these were as valuable as the talks. And so I want to thank my co-director, Nisa, whose knowledge, expertise, humor are extraordinary, as well as our faculty members, John and Debbie, for providing amazing talks and input from their perspectives. I want to thank Eden, who I said is the dynamic engine behind the ASGE's quality assurance and endoscopy and courses like this. And thank you to Eric and Michelle, who are actually behind the curtains doing all the IT logistics. So Nisa, do you have any more comments? And then we'll leave it up to Eden to finish this up. Thank you to all the participants for sticking with us for these four hours this morning and taking a Saturday morning where you could have been, I don't know, here in Dallas defrosting from our recent ice storms, but you could have been doing something else with your Saturday morning. So thank you very much for spending the morning with us. And again, thank you to John and Debbie, Eden, Michelle and Eric. You guys are an amazing team. To my co-director, Gerard, you're fantastic. So thank you guys. Thank you all. So a hot question came in at the end. So I just want the audience to know I will be following up with you all next week on a response to that and keep you informed of when the recordings from this course are going to be available. So you'll hear from me again next week at some point. But thank you so much for joining us today. I want to congratulate everyone for a wonderful course. Our thanks to our faculty, our thanks to you, our participants. As a reminder, each of you will have ongoing access to the recordings from the course via GILeap, ASG's online learning management system, when they are available in roughly three to four weeks. The course evaluation is now available in GILeap. And once you complete it, you can download your certificate. So you don't have to do it today. Maybe it's fresh, top of mind. If you're in there, go ahead and complete it. But you can access it later as well. If you do need assistance logging into GILeap, please email quality at asge.org. And we will get back to you next week. This concludes the ASGE GI Unit Leadership, Restarting Your Quality Program course. We hope this information is useful to you and your practice.

patient safety

endoscopy processing

communication

collaboration

transparency