Minimal Staffing Requirements During Endoscopy
Vanessa M. Shami, MD, FASGE, reviewing Jamil LH, et al. Gastrointest Endosc 2020 Apr.
We all strive to provide the best quality care for patients in our endoscopy units while being cognizant of value-based health care. The non-GI staff, which includes nurses, technicians, and anesthesia providers, present during procedures is variable at different endoscopy centers; this review is to provide recommendations for minimal staffing requirements.
The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) developed a 71-question survey that was answered by 193 endoscopy facilities across 34 states. The majority of responders were medical directors (60%) and hospital-based units (20%). Of the responding facilities, 22% have an average number of 4 rooms per unit and 59% perform >500 endoscopic procedures each month. All endoscopy units perform colonoscopy and upper endoscopy, whereas 27.4% perform EUS, 24.2% perform ERCP, and 34.7% perform the other advanced procedures.
Minimal staffing was reported based on the type of sedation, and it was found that staffing for procedures with both an endoscopy nurse and technician is used most often, regardless of sedation: 51% with no sedation, 43% with moderate sedation, and 46% with an anesthesiology provider. As expected, this dual combination of a nurse and technician was slightly higher for advanced procedures: 80% with moderate sedation, 67% with endoscopist-directed propofol, and 57% with an anesthesiology provider.
Based on the paucity of literature and survey results, the ASGE recommends having one endoscopy staff member present in the room. If no sedation will be given or anesthesia-assisted sedation will be administered, then either a nurse or technician should suffice. Otherwise, a nurse should be present for endoscopist-directed sedation. The only major difference for advanced procedures is the need for a second staff member (either nurse or technician) at the time of the interventional component of the procedure. Additionally, given the current pandemic crisis, minimization of exposure of health care providers is an important consideration.
Comment:
Ultimately, decisions on the number of staff present during an endoscopy depends on a myriad of factors, including overall complexity and/or duration of the case, the number of patient comorbidities, and competency and/or expertise of the staff. As the focus of health care continues to shift toward value-based health care, we need to find a delicate balance between maximizing intraoperative patient safety while minimizing staffing costs:
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Vanessa M. Shami, MD, FASGE
Citation(s):
Jamil LH, Naveed M, Agrawal D, et al. ASGE guideline on minimum staffing requirements for the performance of GI endoscopy. Gastrointest Endosc 2020;91:723-729.e17. (https://doi.org/10.1016/j.gie.2019.12.002)
