Labor Resource Use for Endoscopic Gastric Cancer Screening in Japanese Primary Care Settings: A Work Sampling Study

OBJECTIVE: Endoscopic gastric cancer is screened in primary care settings, but how much resources are required to deliver this service remains unknown. This study determines how much time and human resources are used for endoscopic gastric cancer and for each component of the procedure. MATERIALS AND METHODS: Upper endoscopic procedures were prospectively observed using a work sampling technique. This study analyzed data from patients who underwent upper endoscopic gastric cancer screening at primary care clinics that provide this service. The main outcome measurements were time intervals and total time intervals that considered the numbers of simultaneously engaged workers and were calculated as the product of time intervals and the number of workers, and the labor cost of individual components of each procedure. RESULTS: We observed 44 upper endoscopic procedures at four outpatient clinics. Pre-procedure (preparation and pre-medication), procedure (from intubation to extubation) and post-procedure (recovery and cleaning) accounted for 34.1%, 10.6% and 54.4% of the total time, respectively. Of the overall total time intervals (mean: 4453 person-seconds), 29.3%, 14.4% and 55.7% of the total time was devoted to pre-procedure, procedure and post-procedure, respectively. The post-procedure was the most time- and labor-consuming component from the viewpoints of both total time and labor cost. CONCLUSIONS: Most of the time taken to complete endoscopic gastric cancer screening is consumed by preparation, pre-medication and post-procedures in which nurses play key roles.