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Pediatric penile surgery by a nurse practitioner in the operating room
- Source :
- Journal of pediatric urology. 14(6)
- Publication Year :
- 2018
-
Abstract
- Summary Introduction With the growing shortage of pediatric urological surgeons, it was our aim to streamline our system to get patients with less complex penile procedures performed in a timely manner. To do this, an advanced practice provider (APP) was trained to perform minor penile procedures in children in the operating room(OR). Objectives The goal of our study was to show that with proper training an APP could safely perform a circumcision in the OR. Study design After approval of the study center’s credentialing committee, a NP was trained to perform revisions and initial circumcisions in children in the OR. The process involved: (1) observation, (2) first assisting and (3) performing the procedure with direct, and later in-direct, supervision. The first 100 cases were evaluated for surgical complications, post-operative complications and return rates to the OR. Results 100 independent cases were completed with 90 having only in-direct supervision. There were no operative complications, nor any documented emergency room or urgent care visits in the immediate post-operative period. There were no early returns to the OR and only 1 scheduled follow-up procedure for a penile skin bridge. Discussion It was demonstrated that with proper training a NP can safely perform minor penile procedures in the OR. This allows us to free up our pediatric urology physicians to see and operate on more complex pediatric urology problems. In addition, it allows those with minor penile issues to be cared for more expeditiously. A concern related to training NPs to do circumcisions could be the loss of control by urologists. In this situation, the attending physician is ultimately responsible from a medico-legal standpoint. That would not be true if the NP was practicing independently. With a shortage of urologists, this significantly expands the ability to care for our patient population. In additional, attending surgeons will have a greater freedom to perform major procedures. A limitation of the study was that a patient satisfaction survey was not obtained to see if there were concerns over a APP doing their circumcision. Personal feedback on 30 of the patients that did not return for the follow-up visit was not obtained. The authors of the study are primary providers of pediatric urology care in the study region, thus any individual with concerns would have been referred. Conclusions It was demonstrated that a well-trained APP can safely perform minor penile procedures independently in the OR with indirect supervision. Summary table . Age of child at time of circumcision. Age of child at time of procedure 6–12 months 28 12–24 months 21 3–5 years 19 6–10 years 25 11–13 years 7
- Subjects :
- Male
medicine.medical_specialty
Operating Rooms
Adolescent
Nurse practitioners
Urology
Penile skin
030232 urology & nephrology
Economic shortage
Minor (academic)
Credentialing
03 medical and health sciences
0302 clinical medicine
Patient satisfaction
medicine
Humans
030212 general & internal medicine
Penile surgery
Child
Advanced Practice Nursing
business.industry
Infant
medicine.disease
Pediatric urology
Circumcision, Male
Child, Preschool
Pediatrics, Perinatology and Child Health
Medical emergency
business
Delegation, Professional
Penis
Subjects
Details
- ISSN :
- 18734898
- Volume :
- 14
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Journal of pediatric urology
- Accession number :
- edsair.doi.dedup.....d44eb6c8c7f21643479c75cf9a74414c