The stepwise implementation of a safe and effective Endoscopist-Directed Nurse-Administered Propofol Sedation model of care in Queensland for low-risk endoscopic procedures

Introduction Current models of gastrointestinal endoscopy provision in Queensland are heavily reliant on the use of specialist anaesthetists to deliver sedation. We evaluated the implementation of Endoscopist-Directed Nurse-Administered Propofol Sedation (EDNAPS) as a model of care for low-risk colonoscopy procedures in Queensland. Method Staff were recruited and trained using a combination of face-to-face sessions, self-directed learning and high-fidelity simulation. 118 colonoscopies were performed using EDNAPS and compared to 118 procedures with anaesthetist-delivered sedation (comparison group). A mixed-methods approach was used to collect data regarding the timing, safety and adenoma detection rate, as well as obtaining survey responses from patients and clinicians on the safety and effectiveness. Results Our study found no statistically significant difference in safety or clinical outcomes between the two groups (EDNAPS vs. comparison). However, the time spent in the Post-Anaesthesia Care Unit (PACU) post-endoscopy was significantly shorter in the EDNAPS group ( p < 0.01). 48 Patient Survey responses obtained (21% response rate) were largely in favour of the safety and effectiveness of EDNAPS. Conclusion The findings of our study not only re-affirm the safety and effectiveness of EDNAPS, but also provide a locally endorsed implementation model which can aid in the wider adoption of this practice, statewide and nationally.