Comparing quality, safety, and costs of colonoscopies performed by nurse vs physician trainees.

Autor:	Massl R; Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. Electronic address: r.massl@erasmusmc.n.l., van Putten PG; Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands., Steyerberg EW; Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands., van Tilburg AJ; Department of Gastroenterology and Hepatology, Sint Franciscus Gasthuis, Rotterdam, the Netherlands., Lai JY; Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, the Netherlands., de Ridder RJ; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands., Brouwer JT; Department of Gastroenterology and Hepatology, Reinier de Graaf Medical Center, Delft, the Netherlands., Verburg RJ; Department of Gastroenterology and Hepatology, Medical Center Haaglanden, The Hague, the Netherlands., Alderliesten J; Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, the Netherlands., Schoon EJ; Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands., van Leerdam ME; Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology, Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands., Kuipers EJ; Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2014 Mar; Vol. 12 (3), pp. 470-7. Date of Electronic Publication: 2013 Sep 10.
DOI:	10.1016/j.cgh.2013.08.049
Abstrakt:	Background & Aims: We evaluated the quality and safety of colonoscopies performed by nurse and physician endoscopy trainees as well as the cost differences. Methods: We performed a study of 7 nurse and 8 physician (gastroenterology fellows) endoscopy trainees at 2 medical centers in the Netherlands from September 2008 through April 2012. At the beginning of the study, the subjects had no experience in endoscopy; they were trained in gastrointestinal endoscopy according to the regulations of the Dutch Society of Gastroenterology, performing a minimum of 100 colonoscopies. Each trainee then performed 135 consecutive colonoscopies (866 total by nurse trainees and 1080 by physician trainees) under supervision of a gastroenterologist; the colonoscopies were evaluated for quality and safety. We performed statistical analyses of data, assessing multilevel and cost minimization. The mean age of the patients was 57 years, and about half were women in each group. Results: The endoscopic quality and safety were comparable between nurse and physician trainees. Overall rates of cecal intubation were 95% for nurses and 93% for physicians (P = .38), including procedures that required assistance from a supervisor; mean withdrawal times were 10.4 and 9.8 minutes, respectively (P = .44). Each group detected 27% of adenomas and had a 0.5% rate of complication. In both groups, the rates of unassisted cecal intubation gradually increased with the number of colonoscopies performed, from 70% for nurses and 74% for physicians at the beginning to 89% and 86%, respectively, at the end of the assessment period. Using a strategy in which 1 gastroenterologist supervises 3 nurses, the personnel costs decreased from $64.65 to $54.58. Conclusions: In a supervised setting, nurse endoscopists perform colonoscopies according to quality and safety standards that are comparable with those of physician endoscopist and can substantially reduce costs. (Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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