More than 40,000 low-risk endoscopy patients have been treated under an innovative approach to care at Cairns Hospital, shortening how long they wait for their procedure.
The Endoscopy Unit at Cairns Hospital uses a novel approach for sedation for low-risk endoscopy patients called EDNAPS - endoscopists directed nurse administered Propofol sedation.
This model allows nurses to work to their full scope of practice and the treating doctor to titrate the level of sedation to the patient - reducing the number of staff required for the procedure to just one doctor and two nurses.
Cairns Hospital Director of Gastroenterology Dr Peter Boyd said Cairns Hospital was one of a handful of places in Australia to use an EDNAPS model and it had proven to be an effective model of care for patients and staff.
“It's safer for patients and it's better for patients. It's obviously efficient for the health system, it's cost effective and I believe it will be the future,” Peter said.
“In most endoscopy units in Australia sedation for endoscopy is delivered by specialist anaesthetists, which is clearly much more expensive and labour intensive.
“We have excellent patient satisfaction data with well over 90% of people experiencing no discomfort or no recollection of the procedure.”
Cairns Hospital Endoscopy Unit Acting Nurse Unit Manager Rebecca Healy said the clinical nursing team assess patients who have been referred by their general practitioner or physician to the unit.
“Our team triages whether the patient is appropriate for nursing sedation or if they have multiple co-morbidities that then need an anaesthetist,” Rebecca said.
For patients who do not require an anaesthetist, it is the endoscopist who drives the provision of sedation, supervising a registered nurse who monitors the patient and administers the sedation.
“In each procedure room we have an endoscopist, a nurse who does the sedation and a nurse who assists with the procedures. Nurses do all of our preparations, all the canulas, get them ready with all their monitoring equipment and then they wait for the doctor,” Rebecca said.
“During the procedure the doctor gives us verbal orders for how much propofol and midazolam to give and it takes away the requirement of an anaesthetist and pre anaesthetics.”
After treating than 40,000 patients via the EDNAPS model, there has been almost no adverse reactions recorded and no significant injuries reported.
Nurse practitioner Debra Whittaker said EDNAPS made the experience easier for patients receiving care at Cairns Hospital.
“It streamlines the process for the patients - they don't have blockages to getting a procedure,” Debra said.
“With the open access model they may only see us on the day of their procedure so they don't have to come to multiple appointments. It's very streamlined and efficient.”
While the anaesthetists are just through the door if needed, Dr Boyd said most endoscopy procedures are not high risk – which is reflected by 85 per cent of endoscopy procedures at Cairns Hospital being under the EDNAPS model.
“We still use anaesthetists and we're very happy, we need them for high-risk patients and for high-risk procedures, but most endoscopy is actually not high risk and so we have huge cost savings in that area so we can spend that money on something else,” Peter said.
An additional benefit of the model is that nurses in team to undertake training to gain and hone additional skills, including a yearly medical education resuscitation course, and are mentored by more experienced nursing colleagues. This enables them to maximise their skills to the benefit of their patients.