Assessment of quality indicators among nurse practitioners performing upper endoscopy

Abstract

Background and study aims Limited international data have shown that non-physicians can safely perform upper endoscopy, but no such study has been performed in the United States. Our aim was to assess the quality of outpatient upper endoscopies performed by nurse practitioners (NPs). Patients and methods Retrospective chart review of upper endoscopies performed by 3 NPs between 2010 and 2013 was performed. Comparisons among all NPs performing upper endoscopy and assessment of individual NP performance over time with respect to quality indicators were performed. Results Three NPs performed 333 upper endoscopies (distribution of 166, 44, and 123, respectively). Of the cases, 98.2 %s were successfully completed to the second portion of the duodenum. In most cases, photo-documentation of required anatomical landmarks was performed: GE junction (84.2 %), GE junction in retroflexed view (84.2 %), antrum (82.1 %) and duodenum (80.9 %). Photo-documentation improved with increasing experience. NPs appropriately performed biopsies for specific medical conditions: 10/11 (90.9 %) gastric ulcers were biopsied and 63/66 (95.5) of patients with iron deficiency had duodenal biopsies performed for celiac disease. A physician endoscopist was required during the procedure 22.5 % of the time. Important parameters such as documenting informed consent (100 %) and documenting a discharge plan (99.4 %) in the procedure reports were overwhelming present. There was a single adverse event during the study period. Conclusion In the first US study of NPs performing upper endoscopy, they were able to perform high-quality and safe upper endoscopies. These findings support incorporation of non-physicians alongside physicians to help meet the growing demand for endoscopic services across the United States.

Impact of Advanced Practice Provider Integration into Multispecialty Group Practices on Outcomes Following Major Surgery

“…In a national survey of pediatric surgeons, nearly all respondents endorsed that integration of APPs in inpatient and outpatient settings positively impacted care, particularly with regard to continuity of care, efficiency of service, education of parents and patients, and patient satisfaction. 19 Single-center studies have shown that APPs can safely perform a range of procedures that were previously performed exclusively by physicians, such as thoracostomy insertion, 3 upper endoscopy, 4 and newborn circumcision. 5 In the immediate postoperative period, increased presence of APPs may help with early recognition of patients at risk of clinical deterioration and promote timely escalation of care.…”

“…Most studies on the subject have focused thus far on relatively minor procedures performed within single centers. [3][4][5][6] Evidence from nonsurgical settings suggests that APPs may facilitate the delivery of care through enhanced care coordination and communication and by providing coverage in light of resident duty hour restrictions. 7 Task sharing may allow physicians to focus on patients with complex needs where advanced training may have a larger marginal impact on health outcomes.…”

A realist review protocol of the role and contribution of the advanced nurse practitioner (ANP) in gastroenterology nursing

“…Equally, endoscopy screening remains the preferred and essential intervention method for early diagnosis and treatment of bowel cancer and improved prognosis (Fang et al, 2014;Mendivil et al, 2019). Initially, the role of the ANP in gastroenterology nursing was largely associated with the performance of flexible sigmoidoscopy, but more recently has evolved to include diagnostic and therapeutic, upper and lower procedures (Baumgardner et al, 2017;Department of Nursing, 2020;Vance, 2005;Woods et al, 2006). Diagnostic procedures currently performed include gastroscopy, colonoscopy, and sigmoidoscopy while therapeutic procedures include polypectomy, biopsy, and stenting are undertaken.…”

“…Delayed diagnosis, particularly of patients who received positive screening results and awaiting diagnostic endoscopy confirmation (Burch, 2020), coupled with increases in elective waiting lists and waiting times for endoscopy procedures, may result in health decline and ultimate succumbing to illness. Previous empirical studies associated with the role of the ANP in gastroenterology, focused largely on procedural safety and effectiveness of the role (Baumgardner et al, 2017;Bossa et al, 2006;Massl et al, 2014;Smale et al, 2003). Early randomised control trials (RCTs) concluded that experienced ANPs in gastroenterology can perform screening flexible sigmoidoscopy as safely and effectively as gastroenterologists (Schoenfeld et al, 1999).…”