Sunday, July 20, 2008

I recently had the opportunity to see a colonoscopy at a large medical center's endoscopy suite. Here in the wilderness, our little backwoods hospital does endoscopies in one procedure room within the OR, or in one of the actual ORs if we have two docs doing scopes at the same time. On a very busy day, we might do a total of 14 scopes. So going to the big-town medical center where they do 75 a day was quite a change! I've only been working in endoscopy for six months, and until last week had never seen a scope done at any other hospital; I was looking forward to seeing what was done differently and maybe picking up some tips.

The first big difference I noticed: where is the other nurse? For scopes, we always have both an RN and a scrub nurse or scrub tech in the room. This time, there was just one nurse to push meds, monitor, handle the specimens, and help the gastroenterologist. Admittedly, he was very self-sufficient; the RN never had to hold the scope, apply abdominal pressure, or pass irrigation to the doc. She handed him the biopsy forceps, but that was it. There was a separate team to set up and wash the scopes, which the scrub does at my hospital.

Next big difference: where are the ETCO2 and cardiac monitors? Nowhere! Big-town medical center doesn't include these in their monitoring. I was surprised! I thought they were standard practice.

Yet another big difference: where is the paperwork? There seemed to be a whole lot less paperwork involved than what I have to do. No computer charting, for one thing; there was one paper page each for pre-, intra-, and post-procedure. Very streamlined. The forms were used only for GI endoscopy procedures. There were a few other form such as the permit and physician orders, but that's about it. My hospital uses a standard admission form (used for both pre-op and inpatient admissions), and, for the intra-procedure phase, the same form used for all types of surgery. These are both on the computer. Then I have a paper flowsheet where I document meds and vital signs, along with a handful of other papers: the charge sheet, the charge card, the quality forms (2), the SBAR form, the pathology slip. Not to mention the papers I need to pull from the chart to give to the doc: the physician order form, the surgical consent, the conscious sedation consent, the discharge instructions, the H & P. Too much paperwork!

My manager is setting up a time for me to observe in the endo unit of a local hospital similar in size to mine. I'm curious to see what differences I will find there.