Endoscopist Directed Nurse Administrated Propofol Sedation (EDNAPS)atient Perspectives on Remote Monitoring

Optimised Workforce Utilisation: By enabling nurses to administer propofol under endoscopist supervision, the model reduces reliance on anaesthetists, effectively addressing workforce shortages.

Cost Efficiency: The approach minimises procedural costs by streamlining the team required for endoscopy, involving just one doctor and three nurses.

Enhanced Patient Access: This model has the potential to significantly reduce wait times for low-risk endoscopy patients, ensuring timely care.

High Patient Satisfaction: 95% of patients reported no discomfort or recollection of the procedure, reflecting the model’s success in maintaining safety and comfort.

Scalability and Adaptability: As a result of this successful implementation, the EDNAPS model has proven to be a replicable and scalable solution, adaptable to various healthcare settings while maintaining its effectiveness.

Patient Satisfaction Survey

Rockhampton is utilising the same patient satisfaction survey questions that Cairns are using to enable benchmarking.

The Endoscopist-Directed Nurse-Administered Propofol Sedation (EDNAPS) project was initiated to address critical challenges in healthcare delivery, particularly in the field of endoscopy. The primary issue that led to the project was the shortage of anaesthetists, which created bottlenecks in providing timely access to endoscopic procedures. This shortage was compounded by increasing demand for endoscopy services, driven by the growing prevalence of gastrointestinal disorders and the need for early detection and treatment. As a result, patients faced prolonged wait times, delayed diagnoses, and compromised care quality.

The central question that the EDNAPS project aimed to address was: How can healthcare systems ensure safe, efficient, and cost-effective sedation for endoscopic procedures in the absence of sufficient anaesthetists? This question highlighted the need for an innovative solution that could maintain high standards of patient safety and procedural efficiency while alleviating the burden on anaesthetists.

The EDNAPS project benefits from the expertise of Cairns Hospital, which has successfully implemented this innovative model of care for over 40,000 low-risk endoscopy patients. Cairns Hospital's approach has demonstrated high patient satisfaction and procedural efficiency, making it a benchmark for EDNAPS implementation. Additionally, Central Queensland Hospital and Health Service is fortunate to have a medical officer who previously worked at Cairns Hospital and possesses firsthand experience with EDNAPS. Their critical supervision and insights have been invaluable in ensuring the successful adoption and adaptation of this model within our health service.

While the EDNAPS model has shown promise in many healthcare settings, its implementation has faced challenges in certain locations. Other services have struggled to achieve success with EDNAPS due to a lack of support from their anaesthetic department, which has been a critical barrier to its adoption. In contrast, Rockhampton Hospital has demonstrated the importance of interdisciplinary collaboration by successfully implementing EDNAPS with the strong backing of their anaesthetic department. Their engagement in developing assessment documents and evaluating endoscopists in training has been pivotal in ensuring the model's effectiveness and safety.

The EDNAPS model proposes a paradigm shift by empowering trained nurses to administer propofol sedation under the supervision of endoscopists who are also skilled in sedation. This approach has been designed to optimise workforce utilisation, reduce procedural costs, and enhance access to care. The project has also sought to establish robust training protocols and monitoring systems to ensure the safety and effectiveness of endoscopist directed nurse-administered propofol sedation for the future.

The success of the Endoscopist-Directed Nurse-Administered Propofol Sedation (EDNAPS) project relied heavily on creating a supportive environment. Key factors included strong interdisciplinary collaboration, robust training programs, and the engagement of stakeholders such as endoscopists, anaesthetists, and administrators. The presence of experienced personnel, like the medical officer from Cairns Hospital with firsthand EDNAPS experience, provided critical supervision and insights. Additionally, the project's success was bolstered by the availability of advanced monitoring systems and adherence to stringent safety protocols.

The project highlighted several lessons:

• Importance of Collaboration: Support from the anaesthetic department, as seen in Rockhampton Hospital, was crucial for developing assessment documents and evaluating endoscopists in training.

• Importance of flexibility to adapt the model: Cairns Hospital has a well-established stand-alone Gastroenterology service, where Rockhampton Hospital undertakes more limited endoscopy procedures in a procedure room incorporated into the perioperative environment.  This has required changes to both patient and work flows as well as highlighted the critical need for a change in the nursing structure to support the success of the EDNAPS model of care into the future.

• Importance of patient selection: The model worked best with selection of low-risk patients during implementation and expanding the assessment criteria as both competence and confidence were established.

• Importance of continuous quality improvement:  Specific prelist huddle and post list debrief documents were created to ensure a ‘beginning to end’ and ‘list to list’ focus on managing personal barriers, quality improvement progress and review of critical elements including the use of closed communication, maintaining mutual respect and that speaking up for patient safety foundations are improved, maintained or celebrated.

Strengths, Weaknesses, and Opportunities

• Strengths: The EDNAPS model is demonstrating cost-effectiveness, improved access to care, and high patient satisfaction. It also is optimising workforce utilisation by reducing reliance on anaesthetists.

• Weaknesses: Implementation as an adjunct service raises quality and safety concerns from clinicians that may lead to resistance without purposeful efforts to generate sponsorship and executive commitment. Good communication and patient focussed professional partnership development and investment is required up-front. The limited scope for higher-risk profile patients is an accepted exclusion criteria for patient safety and still facilitate improved access to treat .

• Opportunities: Expanding the model to other health services in Queensland, could further enhance access to endoscopic care. Collaboration with successful sites like Cairns and Rockhampton Hospital could provide valuable insights and continue to grow the strong collaboration towards improving healthcare excellence and forward-thinking models.

What Would You Do Differently?

To address limitations, the project could:

• Strengthen engagement with anaesthetic departments to foster collaboration and support.
• Implement feedback mechanisms to continuously refine the model based on patient and staff input.

Where Else in Queensland Health Can This Project Succeed?

The EDNAPS model has the potential to succeed in health services across Queensland, particularly in areas with high demand for endoscopic procedures and limited anaesthetist availability. Other services could benefit from adopting this innovative approach, leveraging lessons learned from Cairns and Rockhampton Hospitals.

Next Steps

The next steps for the EDNAPS project include:

• Continue to partner with Cairns Hospital to foster the partnership of shared experiences and learnings.
• Establishing partnerships with additional health services to scale the model across Queensland.
• Expanding training programs to include training for new staff.
• Conducting longitudinal studies to assess long-term outcomes and validate the model's effectiveness.