Colorectal cancer ranks third in both incidence and mortality and accounts for 8.6% of cancer diagnoses 

among Veterans in the United States. Colonoscopy is the most widely used screening test for colorectal 

cancer, but access to colonoscopy within the Veterans Health Administration is strained by limited 

capacity and is a barrier to providing timely colorectal cancer screening.  As such, maximizing the 

efficiency of current resources is an important component of the Veterans Health Administration 

strategic plan.  This paper will describe our efforts partnering with the Durham VA Medical Center to 

develop a discrete event simulation model of the GI endoscopy unit and use this model to drive systems 

redesign efforts within the unit.  We will specifically discuss the development and implementation of a 

“case averaging” scheduling schema that we anticipate will improve physician productivity, decrease 

patient waiting time and improve patient and staff satisfaction.