Background: There is increased demand for endoscopies, largely driven by the National Bowel Cancer Screening Program impacting positively to reduce colorectal cancers. However, with a largely uninsured population, this need additionally burdens the already bulging waiting lists in publicly provided endoscopy services. Nurse endoscopy is a tool used to address demand in the UK, Netherlands, USA, and now in Australia and New Zealand. Beyond the key performance indicators for colonoscopy quality, consideration needs to be applied to other performance metrics, such as repeating procedures for interventional therapies, additional clinician involvement to manage complex cases, and potential differences in practice between medical endoscopists and nurse endoscopists.

Aim: Our aim was to determine if the provision of service by nurse practitioner endoscopists (NPEs) is comparable to that of medical endoscopists (MEs) in three areas: performance quality, endoscopic clinical management, and cost‐effectiveness.

Methods: Retrospective data from July 2014 collected for governance of the endoscopy unit for quality assurance and improvement were used by exporting information from Provation MD and MCG to provide time tracking, staff involved in procedures, and whether there were repeated procedures. Unit utilization and cost associated with endoscopy sessions were obtained from financial records.

Results: Performance quality results are shown in Table 1. In terms of endoscopic clinical management, adherence to appropriate surveillance scheduling using National Health and Medical Research Council guidelines documented in the original report was 81.2% by the NPEs and 58.2% by the MEs. Repeat procedures requested because of inability to complete, because of poor preparation, patient anatomy, or anesthetic issues, were 3.3% for the NPEs and 4.9% for the MEs. In 2017, additional measures were collected. Requests for follow‐up in the outpatient clinics by the MEs were 43.2% compared with 21.2% for the NPEs. The disparity between the two groups of endoscopists could be explained by the preference of some MEs to see the patient in the outpatient setting before arranging surveillance. Clinical assistance was sought from an ME in the co‐located endoscopy room or clinic and documented during colonoscopies in 2017 by the NPE in 1.1% of cases and documented by MEs in 0.2% (Table 2). In terms of cost‐effectiveness, non‐salary costs associated with an NPE performing a procedure were the same as for MEs, given that the cost for performing the list excluding the endoscopists is the same with similar room utilization. Therefore, the higher salary associated with MEs represented the biggest cost differential. There was minimal difference in histology cost per procedure ($176 for NPEs and $170 for MEs). The greatest cost–benefit between NPEs and MEs would be the backfilling flexibility, with the NPEs backfilling 37% above scheduled lists, compared with MEs, who were only able to backfill 18.1% of lists due to clinics and inpatient case loads.