Tu1043 RISK OF SERIOUS ADVERSE REACTIONS IN ANESTHESIA-ASSISTED ROUTINE AND COMPLEX LUMINAL ENDOSCOPY PROCEDURES DONE WITHOUT A REGISTERED NURSE IN AN INPATIENT ENDOSCOPY UNIT: EVALUATING MINIMAL STAFFING IN GI ENDOSCOPY

Abstract

Anesthesia assisted (AA) Propofol based sedation is increasing utilized in GI endoscopy across the United States. Paradigm shift from moderate sedation to AA sedation has limited the role of a registered nurse in the procedure room, although they continue to be most important team member in pre-procedure and post-procedure care of the patient. The Society of Gastroenterology Nurses and Associates (SGNA) endorses the presence of at least one RN regardless of anesthesia assistance during all cases. However, this is counter to the recommendations of the American Society of Gastrointestinal Endoscopy (ASGE). Studies looking at the appropriate RN staffing needs in such circumstances are lacking. Primary aim of our study was to evaluate the safety of routine and complex upper and lower luminal endoscopy procedures done with anesthesia help, but without an RN, in an IP endoscopy unit. Retrospective chart review was done of all procedures done between June 2015 and July 2017. Data regarding procedure related serious complications, requiring hospitalization or cardiopulmonary resuscitation (CPR), was manually abstracted reviewed. Relevant Current Procedural Terminology (CPT) codes were used to identify all routine and complex luminal endoscopy procedures. All procedures in the study period were performed with anesthesia assistance with sedation and an endoscopy technician. Routine Luminal Procedures: A total of 3988 routine procedures (2752 upper; 1236 lower endoscopies) were performed in the IP endoscopy unit. Analysis of these procedures showed: 1131 (28.4%) done in ASA-I or ASA-II grade; 2629 (65.9%) in ASA-III or higher grade and ASA was not documented in 228 (5.7%) procedures. Only one (0.025%) patient (ASA-IV) undergoing colonoscopy had serious adverse reaction requiring CPR. Complex Luminal Procedures: A total of 1612 complex procedures (1561 upper; 50 lower) were performed in the IP endoscopy unit (Table 2). Analysis of these procedures showed: 541 (33.6%) done in ASA-I or higher; 958 (59.4%) in ASA-III or higher and ASA documentation could not be found in 113 (7.0%) procedures. One (0.06%) inpatient (ASA-III) required CPR following cardiac arrest during an EGD for GI bleeding. He was intubated and managed in the intensive care unit. The risk of serious adverse reactions remains low for the IP anesthesia-assisted routine and complex endoscopy procedures even in the absence of an RN during the procedure. Adding an additional staff member may add to the healthcare costs. Additional studies from different practice setting and demographics are needed to assess the patient safety, high quality patient care and optimal utilization of resources.