A Multidisciplinary Strategy for Managing Lower Gastrointestinal Endoscopy Waiting Lists Within the ULSS 3 Serenissima Health Authority in the Venice Metropolitan Area.

Background: Lower gastrointestinal endoscopy is a critical diagnostic and therapeutic procedure that is inherently resource-intensive. Following the COVID-19 pandemic, backlogs grew significantly, necessitating innovative management solutions. This study evaluates a multidisciplinary strategy integrating organizational interventions supported by a machine-learning-based semantic appropriateness assessment system to reduce pre-appointment waiting lists within the ULSS (Unità Locale Socio Sanitaria) 3 Serenissima health authority in the Venice metropolitan area. Methods: We retrospectively analyzed administrative and prescription data for adult patients undergoing lower gastrointestinal endoscopy from 2021 to 2024 across five hospitals. Evaluation metrics included the size and composition of the pre-appointment list (first vs. follow-up), service volumes, and prescription trends. Clinical appropriateness was assessed pre-procedure by adherence to RAO (Raggruppamenti di Attesa Omogenea, i.e., Homogeneous Waiting Groups) priority protocols and post-procedure by specialist reviews against guideline-based criteria in two samples from 2023 and 2024. Results: The pre-appointment list decreased significantly from 1, 542 in 2021 to only 14 in 2024. Procedural volume increased (+8% in 2023 vs. 2022), while overall prescriptions decreased, reflecting improved demand management. The provided-to-prescribed ratio rose from 64% in 2021 to 80% in 2024. Furthermore, RAO priority discordance declined, and inappropriate priority-class lower gastrointestinal endoscopy dropped from 26% in 2023 to 21% in 2024-a 5% absolute reduction. Conclusions: A combined strategy targeting both supply and demand-utilizing multidisciplinary governance, computerized decision-support management based on semantic analysis and RAO appropriateness assessment, structured pathways, and continuous audit-was associated with a marked reduction in waiting lists and improved appropriateness while simultaneously increasing service delivery. Expanding specialist-primary care consultation pathways, including teleconsultation, may further consolidate these improvements.