Non-Physician Endoscopy: How Far Can We Go?

Pfeifer, Ute; Schilling, Dieter

doi:10.1159/000443623

Cited by 10 publications

(8 citation statements)

References 31 publications

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“…Meanwhile, Germany was beset by the problem that a growing number of German physicians emigrated abroad. [ 21 , 22 ] Besides, the aging of population is an issue that cannot be ignored. The proportion of the population aged 15–64 has been declining over the 30 years in Germany, which indicates a declining reserve of physicians.…”

Section: Discussionmentioning

confidence: 99%

Global trends of ERCP research in the last 25 years: A bibliometrics study

et al. 2022

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Endoscopic retrograde cholangiopancreatography (ERCP) has been used in clinical practice for over 50 years. This study aims to investigate the current state of research in the field of ERCP.Methods: Web of Science database was searched using the term "ERCP" for articles published between 1994 and 2018. The total number of articles from the top 20 countries with the most published articles was determined. The top 5 countries were compared in terms of output per capita, number of articles published in top journals, cumulative impact factor (IF), and average IF. All annual data were subjected to time-trend analysis. The frequently used terms in the titles and abstracts of all articles were retrieved to conduct co-occurrence analysis to determine the research focus of ERCP.Results: A total of 9960 articles on ERCP were published between 1994 and 2018, of which 8778 articles were from the top 20 producing countries. There was a significant positive correlation between the output and GDP of each country (R = 0.870, P = .001). The United States of America (USA), Japan, Germany, Italy, and China were the top 5 producing countries with 3190 (32.0%), 868 (8.7%), 658 (6.6%), 512 (5.1%) and 488 (4.9%) articles published, respectively. The USA, Japan, Italy, and China were trending upwards in the total outputs and outputs per capita, while Germany were trending downwards. For average IF, Germany had a downwards trend, while the other 4 countries remained stable. Overall, the USA had the highest output per capita (97.5/10 million) and the highest average IF (6.454). China had the lowest output per capita (3.5/10 million) and average IF (3.125). The ERCP procedures for sphincter of Oddi dysfunction, the combination of ERCP, and laparoscopic cholecystectomy have been the research focus of ERCP.Conclusions: Except for Germany, research on ERCP will continue to increase in the top-producing countries. The outputs per capita and quality of articles from developed countries are higher than those from developing countries.

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Section: Discussionmentioning

confidence: 99%

Global trends of ERCP research in the last 25 years: A bibliometrics study

et al. 2022

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“…Concerns that a medical rather than a nursing focus gains dominance when the nursing role expands have been reported [ 30 ]. In addition, studies have suggested distrust and concern among medical doctors around responsibility and clinical quality and safety when nurses take over clinical tasks from doctors [ 4 , 14 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Factors perceived to influence implementation of task shifting in highly specialised healthcare: a theory-based qualitative approach

Feiring

Lie

2018

BMC Health Serv Res

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BackgroundNew approaches to control healthcare expenditures and increase access to quality care are required by decision-makers in high-income countries. One strategy is to reallocate tasks from doctors to nurses. Evidence suggests that quality, effectiveness and efficiency of task shifting are context sensitive and affected by implementation. However, little is known about implementability of task shifting in specialised healthcare. We aimed to identify factors perceived to influence implementation of doctor-to-nurse task shifting in a hospital setting and improve understanding of task shifting implementability by using theory-based frameworks for analysing behaviour. Nurse-led bone marrow examination exemplified task shifting from the medical to the nursing domain.MethodsDoctors and nurses (n = 17) in a haematology department at a Norwegian university hospital were asked about factors perceived to influence implementation of nurse-led bone marrow aspirations and biopsies. Methods included in-depth semi-structured interviews (n = 11) and focus-group discussion (n = 6). Data were analysed using the Capability, Opportunity, and Motivation behaviour model and the Theoretical Domains Framework.ResultsTen factors perceived to influence implementation were identified. Three factors were related to capability, including (1) knowledge and acceptability of task shifting rationale; (2) dynamic role boundaries; and (3) technical skills to perform biopsies and aspirations. Five factors were related to motivation, including (4) beliefs about task shifting consequences, such as efficiency, quality and patient satisfaction; (5) beliefs about capabilities, such as technical, communicative and emotional skills; (6) job satisfaction and esteem; (7) organisational culture, such as team optimism; and (8) emotions, such as fear of informal nurse hierarchy and envy. The last two factors were related to opportunity, including (9) project planning and leadership, and voluntariness; and (10) patient preferences.ConclusionTask shifting from doctors to nurses in specialised healthcare requires not only development of technical skills but also complex changes in organisation, clinical routines and role identity. Educational and organisational interventions to build a team-oriented culture could potentially increase the possibility of successful task shifting and stimulate nurses to take on untraditional responsibilities. Environmental restructuring to support doctors using their time in activities only doctors can perform may be needed to realise potential efficiency gains.

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“…One possible solution, as suggested in a recent review 26 , is to test incorporation of non-physicians in a smaller setting before incorporating on a larger scale. The authors acknowledge the competing concerns that the number of procedures are increasing but it is not known whether non-physicians can consistently deliver high-quality care or if their participation is cost-effective.…”

Section: Discussionmentioning

confidence: 99%

Assessment of quality indicators among nurse practitioners performing upper endoscopy

2017

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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.

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Non-Physician Endoscopy: How Far Can We Go?

Cited by 10 publications

References 31 publications

Global trends of ERCP research in the last 25 years: A bibliometrics study

Global trends of ERCP research in the last 25 years: A bibliometrics study

Factors perceived to influence implementation of task shifting in highly specialised healthcare: a theory-based qualitative approach

Assessment of quality indicators among nurse practitioners performing upper endoscopy

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