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Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial

Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial
Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial
Objective: To determine whether preoperative assessments carried out by appropriately trained nurses are inferior in quality to those carried out by preregistration house officers.

Design: Randomised controlled equivalence/non-inferiority trial.

Setting: Four NHS hospitals in three trusts. Three of the four were teaching hospitals.

Participants: all patients attending for assessment before general anaesthesia for general, vascular, urological, or breast surgery between April 1998 and March 1999.
Intervention: Assessment by one of three appropriately trained nurses or by one of several preregistration house officers.

Main outcome measures: History taken, physical examination, and investigations ordered. Measures evaluated by a specialist registrar in anaesthetics and placed in four categories: correct, overassessment, underassessment not affecting management, and underassessment possibly affecting management (primary outcome).

Results: 1907 patients were randomised, and 1874 completed the study; 926 were assessed by house officers and 948 by nurses. Overall 121/948 (13%) assessments carried out by nurses were judged to have possibly affected management compared with 138/926 (15%) of those performed by house officers. Nurses were judged to be non-inferior to house officers in assessment, although there was variation among them in terms of the quality of history taking. The house officers ordered considerably more unnecessary tests than the nurses (218/926 (24%) v 129/948 (14%).

Conclusions: there is no reason to inhibit the development of nurse led preoperative assessment provided that the nurses involved receive adequate training. However, house officers will continue to require experience in preoperative assessment.
surgery, non-u.s.gov't, hospital, teaching, medical staff, multicenter studies, standards, nursing evaluation research, comparative study, research support, physical examination, design, nurses, medical history taking, hospitals, public, history, clinical-trial, patients, outcome assessment (health care), humans, clinical competence, preoperative care, referral and consultation, nursing audit, quality of health care, nursing staff, nursing, england
0959-8138
1323-1326
Kinley, Helen
004ceec1-b7e6-4ae4-8221-0ccc811e4bd8
Czoski-Murray, Carolyn
9291da81-86cc-4d3f-bff9-98c488f54c75
George, Steve
bdfc752b-f67e-4490-8dc0-99bfaeb046ca
McCabe, Chris
00e209b8-1190-410d-b254-5f4d9cb050d2
Primrose, John
d85f3b28-24c6-475f-955b-ec457a3f9185
Reilly, Charles
c7935eaf-a6d6-48a7-b991-8c85f650b788
Wood, Richard
fa173eb1-9e26-4d9f-8d90-0c48d5586f94
Nicolson, Paula
1b863647-d5d1-492d-a08e-1948a50da1d6
Healy, Caroline
c825851c-a65b-4df8-ae6f-d758f00389d1
Read, Susan
04372870-ed9e-4153-8dca-2daed4d0c934
Norman, John
1b7926ec-f3b4-44bc-9980-cc0d42df947e
Janke, Ellen
688881f6-1fdf-4647-9c6c-3c36339590cb
Alhameed, Hameed
48d401bc-0964-4b3b-813f-70b07ef3282f
Fernandes, Nick
303542aa-cf0a-41c4-86e8-83522bd84043
Thomas, Eileen
f1a0ddf8-cb54-4f29-baf4-c6c79ba5e1e2
OpCheck Study Group
Kinley, Helen
004ceec1-b7e6-4ae4-8221-0ccc811e4bd8
Czoski-Murray, Carolyn
9291da81-86cc-4d3f-bff9-98c488f54c75
George, Steve
bdfc752b-f67e-4490-8dc0-99bfaeb046ca
McCabe, Chris
00e209b8-1190-410d-b254-5f4d9cb050d2
Primrose, John
d85f3b28-24c6-475f-955b-ec457a3f9185
Reilly, Charles
c7935eaf-a6d6-48a7-b991-8c85f650b788
Wood, Richard
fa173eb1-9e26-4d9f-8d90-0c48d5586f94
Nicolson, Paula
1b863647-d5d1-492d-a08e-1948a50da1d6
Healy, Caroline
c825851c-a65b-4df8-ae6f-d758f00389d1
Read, Susan
04372870-ed9e-4153-8dca-2daed4d0c934
Norman, John
1b7926ec-f3b4-44bc-9980-cc0d42df947e
Janke, Ellen
688881f6-1fdf-4647-9c6c-3c36339590cb
Alhameed, Hameed
48d401bc-0964-4b3b-813f-70b07ef3282f
Fernandes, Nick
303542aa-cf0a-41c4-86e8-83522bd84043
Thomas, Eileen
f1a0ddf8-cb54-4f29-baf4-c6c79ba5e1e2

Kinley, Helen, Czoski-Murray, Carolyn, George, Steve, McCabe, Chris, Primrose, John, Reilly, Charles, Wood, Richard, Nicolson, Paula, Healy, Caroline, Read, Susan, Norman, John, Janke, Ellen, Alhameed, Hameed, Fernandes, Nick and Thomas, Eileen , OpCheck Study Group (2002) Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial. British Medical Journal, 325 (7376), 1323-1326. (doi:10.1136/bmj.325.7376.1323).

Record type: Article

Abstract

Objective: To determine whether preoperative assessments carried out by appropriately trained nurses are inferior in quality to those carried out by preregistration house officers.

Design: Randomised controlled equivalence/non-inferiority trial.

Setting: Four NHS hospitals in three trusts. Three of the four were teaching hospitals.

Participants: all patients attending for assessment before general anaesthesia for general, vascular, urological, or breast surgery between April 1998 and March 1999.
Intervention: Assessment by one of three appropriately trained nurses or by one of several preregistration house officers.

Main outcome measures: History taken, physical examination, and investigations ordered. Measures evaluated by a specialist registrar in anaesthetics and placed in four categories: correct, overassessment, underassessment not affecting management, and underassessment possibly affecting management (primary outcome).

Results: 1907 patients were randomised, and 1874 completed the study; 926 were assessed by house officers and 948 by nurses. Overall 121/948 (13%) assessments carried out by nurses were judged to have possibly affected management compared with 138/926 (15%) of those performed by house officers. Nurses were judged to be non-inferior to house officers in assessment, although there was variation among them in terms of the quality of history taking. The house officers ordered considerably more unnecessary tests than the nurses (218/926 (24%) v 129/948 (14%).

Conclusions: there is no reason to inhibit the development of nurse led preoperative assessment provided that the nurses involved receive adequate training. However, house officers will continue to require experience in preoperative assessment.

Full text not available from this repository.

More information

Published date: 7 December 2002
Keywords: surgery, non-u.s.gov't, hospital, teaching, medical staff, multicenter studies, standards, nursing evaluation research, comparative study, research support, physical examination, design, nurses, medical history taking, hospitals, public, history, clinical-trial, patients, outcome assessment (health care), humans, clinical competence, preoperative care, referral and consultation, nursing audit, quality of health care, nursing staff, nursing, england

Identifiers

Local EPrints ID: 24365
URI: http://eprints.soton.ac.uk/id/eprint/24365
ISSN: 0959-8138
PURE UUID: a24433b7-51ef-4249-9597-659767573bc6
ORCID for John Primrose: ORCID iD orcid.org/0000-0002-2069-7605

Catalogue record

Date deposited: 30 Mar 2006
Last modified: 17 Dec 2019 01:59

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