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Indexed/Abstracted in: CAB, EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Cappell M. S.
Division of Gastroenterology, William Beaumont Hospital, Royal Oak, MI, USA
Improper performance by a nurse of a medical study/procedure (e.g., video capsule endoscopy performed on a wrong patient) raises novel, previously unexplored questions regarding: 1) whether the study should subsequently be interpreted; 2) which physician should interpret the study; and 3) whether study interpretation requires another informed consent due to the extraordinary circumstances. Two such cases are reported. First, the Chief of Gastroenterology (GI) contacted the hospital ethics committee regarding procedure interpretation after the wrong patient underwent video capsule endoscopy by a nurse. The committee recommended to inform and apologize to the patient about the nursing error, to not charge for this study, and to interpret the study, likewise without charge, provided that a new informed consent was obtained that included discussion of the small potential patient benefit of study interpretation in this circumstance. These recommendations were followed. Study interpretation revealed a 3 mm wide characteristic angiodysplasia in the distal jejunum. Endoscopic therapy was not performed due to the small lesion size, and absence of gastrointestinal bleeding or significant anemia. Second, the Chief of GI was informed of an esophageal manometry performed for chronic dysphagia that had not been interpreted for 7 months due to its being performed by a nurse without any arrangement for a gastroenterologist to interpret the study. The referring gastroenterologist lacked training or privileges in esophageal manometry. The Chief of GI arranged for a motility expert to interpret the study. The study was read as technically inadequate because the nurse had been unable to intubate the stomach and the referring gastroenterologist had declined to assist in this difficult intubation. The motility expert noted that had he been involved earlier in the case he would have himself attempted gastric intubation. In conclusion, a reasonable approach to a medical study improperly performed by a nurse includes: 1) inform and apologize to the patient about the error; 2) obtain informed consent for study interpretation, and 3) interpret the study at no charge. Consultation with an institutional Ethics Committee is advisable. An interpreting physician should be identified at the time of scheduling a medical study. Although illustrated for GI studies, these recommendations pertain to studies performed by nurses or technicians in numerous medical fields, such as echocardiograms or pulmonary function tests.