JAG do not mandate the skill mix and number of staff that they would expect to see in an endoscopy service. This is in recognition that the environments in which endoscopy is undertaken varies widely, as do the complexity of procedures undertaken and the acuity of patients seen. These factors alone alter staffing requirements.
The BSG guidance (Dunkley et al, 2017) on safe staffing of endoscopy units is the recommended guidance to be considered when reviewing staffing levels. This document does not mandate staffing levels but focuses on the importance of competency of individuals when considering numbers and skill mix
When assessing services, JAG needs to be assured that there are safe and competent staff across all areas of the patient pathway. This includes any area external to the unit where GI endoscopy is performed such as theatres, radiology or outpatients and also includes the decontamination area.
The assessment team will look for evidence of:
- an annual review of staffing levels and skill mix. This should take into consideration expected service developments and expansion, including any planned appointments to support new work. This should include clinical, administrative and support staff
- use of bank and agency staff, the percentage of the total workforce they represent at any one time and how their competency to undertake the role is assessed
- sickness and absence rates and how these are monitored and managed
- demonstrable competencies for all staff groups. These should be evidence based, up to date, validated and annually revalidated and include all staff involved in the patient journey through endoscopy
- evidence of an annual survey of all staff groups to understand how they view their working conditions with an action plan to resolve issues where appropriate.
JAG looks specifically to ensure that:
- the reception area is manned at all times when the unit is open
- there is a competent person overseeing all pre assessment areas. In particular when patients are waiting in enclosed areas, such as changing rooms, for their procedure
- there is a registered health care professional responsible for each stage of the patient pathway, delegating to non registered staff in a safe manner
- there is a minimum of two competent staff in the procedure room, one of whom is a registered nurse. Increased staffing may be required in the room to support more complex and emergency procedures and there should be evidence of a risk assessment to support this
- where there are gender segregated recovery areas, there is a competent person at all times in each area. A registered health care professional oversees all areas and there are additional competent staffing to support the discharge process, ensuring that the recovery area is never left unmanned. It should be noted that delegation of the discharge process is ultimately the responsibility of the endoscopist.
Consideration should be given to:
- including the role of a list coordinator where there are multiple procedure rooms to ensure the smooth running of each room and to mange the expectations of patients waiting.
- the use of porters and housekeepers to support non-clinical functions.
Dunkley I et al (2017) UK consensus on non medical staffing required to deliver safe quality assured care for adult patients undergoing gastrointestinal endoscopy. https://www.bsg.org.uk/resource/uk-consensus-on-non-medical-staffing-required-to-deliver-safe--quality-assured-care-for-adult-patients-undergoing-gastrointestinal-endoscopy.html