Author(s): Maximilian Stephens, Luke F Hourigan, Mark Appleyard, George Ostapowicz, Mark Schoeman, Paul V Desmond, Jane M Andrews, Michael Bourke, David Hewitt, David A Margolin, Gerald J Holtmann, Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Faculty of Medicine and Biomedical Sciences, University of Queensland, Department of Gastroenterology and Hepatology, RBWH, Department of Gastroenterology and Hepatology, Gold Coast Hospital QLD 4215, Department of Gastro-enterology and Hepatology, Royal Adelaide Hospital and University of Adelaide, St Vincent’s Hospital, University of Melbourne, Melbourne VIC 3010, Australia, Department of Gastroenterology and Hepatology, Westmead Hospital, University of Sydney, School of Medicine, University of Queensland, Department of Gastroenterology, Queensland Elizabeth II Jubilee Hospital, Coopers Plains, Brisbane QLD 4108, Australia, Department of Colon and Rectal Surgery Ochsner Clinic Foundation, Ochsner Clinical School, University of Queensland
Pages: 5056-5071
Year: 2015 Issue:  16
Journal: World Journal of Gastroenterology
Keyword:  Nurse endoscopist; Cost-benefit; Service model; Patient satisfaction; Outcome parameter;
Abstract: AIM:To examine the available evidence on safety, competency and cost-effectiveness of nursing staff providing gastrointestinal(GI) endoscopy services.METHODS:The literature was searched for publications reporting nurse endoscopy using several databases and specific search terms.Studies were screened against eligibility criteria and for relevance.Initial searches yielded 74 eligible and relevant articles; 26 of these studies were primary research articles using original datasets relating to the ability of nonphysician endoscopists.These publications included a total of 28883 procedures performed by non-physician endoscopists.RESULTS:The number of publications in the field of non-specialist gastrointestinal endoscopy reached a peak between 1999 and 2001 and has decreased thereafter.17/26 studies related to flexible sigmoidoscopies,5 to upper GI endoscopy and 6 to colonoscopy.All studies were from metropolitan centres with nurses working under strict supervision and guidance by specialist gastroenterologists.Geographic distribution of publications showed the majority of research was conducted in the United States(43%),the United Kingdom(39%)and the Netherlands(7%).Most studies conclude that after appropriate training nurseendoscopists safely perform procedures.However,in relation to endoscopic competency,safety or patient satisfaction,all studies had major methodological limitations.Patients were often not randomized(21/26studies)and not appropriately controlled.In relation to cost-efficiency,nurse endoscopists were less costeffective per procedure at year 1 when compared to services provided by physicians,due largely to the increased need for subsequent endoscopies,specialist follow-up and primary care consultations.CONCLUSION:Contrary to general beliefs,endoscopic services provided by nurse endoscopists are not more cost effective compared to standard service models and evidence suggests the opposite.Overall significant shortcomings and biases limit the validity and generalizability of studies that have explored safety and quality of services delivered by non-medical endoscopists.