February 26th, 2009
Should Nurses Be Performing Endoscopy?
Two provocative articles recently appeared in BMJ (here and here) showing that experienced, well-trained nurses are as clinically effective — but not as cost-effective — as physicians in performing diagnostic upper endoscopy and sigmoidoscopy.
This randomized trial definitively answers the question of whether nurses can deliver high-quality endoscopy, but the larger question is whether they should be performing these procedures. I think they should, but only if they’ve been trained in both the technical performance of endoscopy and the management of digestive diseases (this, by the way, goes for physicians as well!). Endoscopy is, after all, not just a procedure, but a tool used to detect, diagnose, and treat GI disease. When it is used as such, the outcomes are usually good, as demonstrated in the BMJ articles. When it is treated simply as a procedure, however, outcomes can be poor, and one is left to wonder whether the tool is being wielded simply as an income generator.
2 Responses to “Should Nurses Be Performing Endoscopy?”
M. Brian Fennerty, MD
Editor-in-Chief
NEJM Journal Watch Gastroenterology
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I believe Dr. Fennerty’s question regarding whether nurses should perform endoscopies (although we apparently can) is a bugaboo; there is no reason why nurses cannot safely and reliably perform screening endoscopies, as this and prior studies have shown. Nurses are not requesting privileges to perform endoscopic treatments or to evaluate treatment in those with diagnosed GI illnesses in this country. Rather than impinge on physician practice, nurse endoscopists could free specialist physicians to do the treatment and evaluation functions they are trained to do.
Regarding the cost-effectiveness question addressed in the Richardson study, the metrics used to evaluate cost-effectiveness in the UK must be very cautiously interpreted for application to the US. Please interpret the statistically non-significant trend favoring physicians with great caution, readers.
Dear sir, for your question regarding whether nurses should perform endoscopies, I think it is better nurses train patients about performing endoscopy, after procedure services, vital signs during procedure and drugs, filling research questionnaire, and write and report their final accurate exam of patient. Regarding a patient with an esophageal web or gastric fistula that every moment may end to complications, how they would manage the problem even if had perfomed endoscopy after about 20 simulations endoscopy and licence. But there are many countries than even general physicians are not allowed to perform endoscopy. thanks