title: Comparing quality, safety, and costs of colonoscopies performed by nurse vs physician trainees.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. Electronic address: r.massl@erasmusmc.n.l.
authors.forename: Renate
authors.initials: R
authors.lastname: Massl
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: Paul G
authors.initials: PG
authors.lastname: van Putten
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Department of Gastroenterology and Hepatology, Sint Franciscus Gasthuis, Rotterdam, the Netherlands.
authors.forename: Anthonie J P
authors.initials: AJ
authors.lastname: van Tilburg
authors.affiliation: Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, the Netherlands.
authors.forename: Jonathan Y L
authors.initials: JY
authors.lastname: Lai
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Rogier J J
authors.initials: RJ
authors.lastname: de Ridder
authors.affiliation: Department of Gastroenterology and Hepatology, Reinier de Graaf Medical Center, Delft, the Netherlands.
authors.forename: Johnannes T
authors.initials: JT
authors.lastname: Brouwer
authors.affiliation: Department of Gastroenterology and Hepatology, Medical Center Haaglanden, The Hague, the Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Verburg
authors.affiliation: Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
authors.forename: Joyce
authors.initials: J
authors.lastname: Alderliesten
authors.affiliation: Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Schoon
authors.affiliation: 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.
authors.forename: Monique E
authors.initials: ME
authors.lastname: van Leerdam
authors.affiliation: 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.
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003113:Colonoscopy / Q000009:adverse effects* / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009726:Nurses; D010820:Physicians; D011446:Prospective Studies; D011787:Quality of Health Care / Q000706:statistics & numerical data*
keywords: Colonoscopy Screening; Nurse Endoscopist; Quality Assessment