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.