Scope of Service

Overview:

• Size of the unit: 18 beds for pre and post patient care/4 procedure rooms
• Source of the patients: Inpatients and Outpatients

Types and Ages of Patients Served:

• Primary population of patients: Outpatients and inpatients undergoing an endoscopy procedure.
• General age of your population: Adult through geriatric. Pediatric procedures are done in the PICU with direct care provided by a pediatric nurse.

Description of Internal and External Customers:

Internal customers served include other nursing units, physicians, patients, families, and all ancillary departments of the hospital. External customers we serve include, but are not limited to: home health care services, area nursing homes, area rehabilitation facilities, medical supply companies, other contracted medical service companies, outlying hospitals, and the local community.

Conditions and Diagnosis Treated:

Conditions treated on the unit may include, but are not limited to: GI bleed, Barrett’s esophagitis, GERD, varices, anemia, hematemesis, epigastric pain, dysphagia, mass, melena, abnormal x-ray/CT scan, nausea, vomiting, weight loss, common bile duct stones, GERD not responding to PPI treatment, abdominal pain, rectal bleeding, chronic diarrhea, history of polyps, change in bowel habits, irritable bowel syndrome, family hx of colon cancer, Crohn’s, colitis, and atrial fibrillation.

Types of Services & Care Provided:

Services provided include: Endoscopy procedures performed for diagnosis and/or therapeutic purposes include bronchoscopy, upper and lower endoscopy, dilation, liver biopsy, paracentesis, esophageal manometry, 24 hour pH monitoring, feeding tube placement and replacement, and transesophageal echocardiogram. Other special procedures requiring fluoroscopy include endoscopic retrograde cholangiopancreatography (ERCP), and colon/esophageal stent placement. Emergency care/procedures are provided after hours and on weekends with on-call RN’s and PCA if necessary.

Bronson now has technology to perform endoscopic ultrasound (EUS) for the diagnosis and staging of gastrointestinal abnormalities. Plans for the future include adding endoscopic brochial ultrasound (EBUS) to help with the diagnosis of cancer in patients.

The nursing staff is provided by a team consisting of: A Charge RN oversees daily activities of the unit. A Nurse Manager has overall responsibility of the unit and is under the direction of a Nursing Director. The Nurse Manager oversees the staff members made up of patient care associates, registered nurses, and the unit clerk The surgical services float pool, BSS staff, and on call staff are also available for alternative staffing needs and consists of registered nurses and PCA’s.

There is a minimum staffing of one RN per procedure room and PCA to clean scopes and assist in labs. Pre/post procedure care is 1 RN to 4 patients, and 1 PCA to 8 patients.

Medical care for patients: Physicians who use the unit for endoscopy procedures include gastroenterologists, colon/rectal surgeons, general surgeons (on occasion), cardiologists, and pulmonologists. House staff involvement is minimal and is always under the direction of one of the physicians. Physician assistants round for the gastroenterologists to help coordinate care for the inpatients.

Other multi-disciplinary team members involved in the care of the patient include: A Clinical Instructor from Education Services is utilized as necessary to assist with orientation, inservices, and educational opportunities. A dietician and case manager is available for specialized dietary and/or home care needs as appropriate for the patient per physician orders. Cardiovascular technicians assist with TEE’s.

Sites Where Services & Care is Provided:

• General Units: Endoscopy staff travels to general units & the emergency room to do endoscopy procedures after hours and on weekends. Procedures include duodenoscopy, colonoscopy, and bronchoscopy. Pediatric patients are done in PICU so that the pediatric sedation team is able to sedate the patient and the endoscopy staff assists with the procedure.
• Critical Care Units: Most diagnostic/therapeutic services for critical care patients are provided at the bedside. They include duodenoscopy, colonoscopy, bronchoscopy, and percutaneous tracheostomy. Nursing staff and PCA’s assist with procedures as appropriate for the patients. Other procedures performed at the bedside include, but are not limited to foreign body removal, polypectomy, banding, sclerosing, clipping, and hemostasis therapy.
• Procedural Area: Services are provided within the department for the list of procedures performed above.
• Surgical Area: All procedures performed in the General Units, Procedural Area, and Critical Care Units are also performed on a limited basis in the surgery area as well.

Times When Services & Care is Provided:

Procedures are done on outpatients and inpatients: Monday – Friday, 0700-1730. Inpatient care / emergency room is provided after hours, weekends, and holidays for inpatients not accommodated by the outpatient schedule, with the on-call staff. On-call staff is available anytime the department is not open.