Endoscopy Center without RN in procedure room ??

[hatfieldrocks]

Hi! I work at an endoscopy center in Indiana. Right now we have 4 rooms running all day. Each room has a M.D., CRNA, RN, and Tech (sometimes interchanged with CST). We give propofol, administered by CRNA. The RN is responsible for charting and helping with the procedure. While the tech is responsible for assisting the RN or maintenance of equipment. Our facility is looking at implementing a new system where the RN is no longer needed in the procedure room. The CRNA and tech/cst will split the duties of the RN. I was curious if anyone is familiar with this technique? If so, what are the pros vs cons. Thanks!

[lindarn]

So it begins. Just another attempt to provide health care by cutting out the professional services of an RN. We will be obsolete in another 20 years, folks. Just what hospital administraters and insurance companies have been planning for years. Their dream of running a nurseless hospital is finally coming to fruition.

Better get on the bandwagon, and protest when we get eminated like this, to the detriment to the patient. We are going the way of the wind, getting cut out of our professional practice, and we are not even firing a shot.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN (ret)

Somewhere in the PACNW

[RNsRWe, ASN, RN]

Might want to see what your accreditation agency has to say about that. Don't think it'd fly with them, which means it won't fly, period.

[Horseshoe, BSN, RN]

I work in an endoscopy center and RNs are not in the rooms, and the procedures go just fine. MD, CRNA, GI tech only, though we have one RN who floats between rooms to assist if needed.

We are fully accredited and our patient outcomes are great and their patient satisfaction ratings are quite high.

[MissChrissy]

Your set up seems like overkill. You only need a CRNA/Anesthesiologist, a Gastroenterologist, and a Tech.

I work at an endoscopy clinic as tech. I'm not exactly sure what you mean by charting. Generally the charts (which are all electronic now) are prepared prior to the procedure. I assist the doctor fully with the procedures (polypectomy, biopsy, irrigation, dilation etc). I set up each room and put everything in the computer system (i.e., start/cecum/end time, location/type/what device was used to extract the polyp/biopsy, etc). The Anesthesiologist or CRNA are responsible for monitoring the patient, on the computer- putting in the vitals, how much medication was administered, times, the gastroenterologist's preliminary diagnosis after the procedure is over and patient's chief complaints for billing purposes.

I don't really see any cons, except for the RN being phased out of that area. I think it is really just being cost effective. Why would they pay the salary of an RN when a tech can handle it?

[classicdame, MSN, EdD]

the obvious disadvantage in my view is that, should an emergency occur, the CRNA would be busy with the airway and no one else could do nursing duties.

[MissChrissy]

the obvious disadvantage in my view is that, should an emergency occur, the CRNA would be busy with the airway and no one else could do nursing duties.

I don't think it would be a disadvantage imo. There's still another MD/OD in the room, even though the anesthesiologist/CRNA would be running the show. Techs can start another IV line, perform chest compression, assisting the doctors/CRNA with airway management, setting up equipment and getting the needed medication. In a clinic setting you're only providing resuscitation efforts until the paramedics/EMTs arrive which *SHOULD* be less than 10 minutes, and for us 3-5 minutes considering our clinic has one right across the street.

[MissChrissy]

If the clinic is responsible and only scopes patients that are reasonably healthy (certain BMI cut off, ASA of 1 or 2, non-emergent cases, etc) then emergency situations should be a pretty rare occurrence. The main time when we have to call 9-1-1 or there's some airway issues is when the patient clearly should have been seen at a hospital instead of an outpatient facility.

[CaliLoveRN]

Tech starting an IV line? Our tech's are not allowed to start IV's. They are strictly Endoscopy Technicians (setting up scopes, cleaning, etc.).

[MissChrissy]

Tech starting an IV line? Our tech's are not allowed to start IV's. They are strictly Endoscopy Technicians (setting up scopes, cleaning, etc.).

I guess different places have different scope of practice. We can start IVs as techs and set up saline drips for dehydrated patients. Most of the techs have been cross trained to do pre-op which requires starting the IV. The anesthesiologist only starts it when it's a particularly difficult stick. I don't feel like starting an regular IV is rocket science but I do feel it takes a good bit of on the job training to get the hang of it and learn any little tricks of the trade.

Its not like we're starting a central line, it's a simple stick with a 24 or 22G.

[CWONgal]

I'm curious...I'd like to know if we are talking outpatient clinics or an endoscopy suite located in a hospital. Seems as though some of what is being mentioned pertains to outlying clinics where you are dealing with cattle call, big buck endoscopy. Roll them in and roll them out. GI docs will take CRNA's and propofol and say adios to standard versed/fentanyl administered by RN's for those quick turn over times. Additionally, they have to find a way to pay those 120,000+ CRNA salaries.

[momRNmy]

I'm curious...I'd like to know if we are talking outpatient clinics or an endoscopy suite located in a hospital. Seems as though some of what is being mentioned pertains to outlying clinics where you are dealing with cattle call big buck endoscopy. Roll them in and roll them out. GI docs will take CRNA's and propofol and say adios to standard versed/fentanyl administered by RN's for those quick turn over times. Additionally, they have to find a way to pay those 120,000+ CRNA salaries.[/quote']

Most of the GI docs at my facility prefer propofol, but there are the few who actually prefer screening colons, TRUS, and flex sigs under moderate sedation as they believe propofol can relax sphincter control too much and make insufflation of the lower GI tract difficult.