Nurses could be trained to provide pre-operative assessment of equivalent quality to junior doctors

Miles, Kevin PhD, MSc, Dip Nurs, RGN
Primrose, Dr J

Camden Primary Care Trust and Royal Free & University College Medical School; London, United Kingdom (Miles)
University of Southampton; United Kingdom (Primrose)

Abstracted from:Kinley H, Czoski-Murray C, George S et al. Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial. BMJ 2002; 325: 1323-1328 .

Sources of funding: National Coordinating Centre for Health Technology Assessment (NCCHTA).

Correspondence to: J Primrose, University Surgery, University of Southampton, School of Medicine, Southampton General Hospital, United Kingdom. Email: [email protected]

Abstract provided by Bazian Ltd, London

Evidence-based Healthcare 7(2):p 60-62, June 2003.

BACKGROUND

There is increasing pressure to substitute non-clinical staff in many aspects of medical care. Research on nurse substitution for junior doctors in pre-operative assessment has been of limited size and scope.

OBJECTIVE

To assess whether appropriately trained nurses can conduct pre-operative assessments of similar quality to those carried out by pre-registration house officers.

SETTING

Three teaching hospitals and one non-teaching hospital in the United Kingdom; April 1998 to March 1999.

METHOD

Randomised equivalence trial.

PARTICIPANTS

1874 people receiving preoperative assessment before general anaesthesia for vascular, urological, breast or general surgery in four hospitals. Mean age 57 years; 48% female. Three nurses and an unspecified number of house officers participated. Before examining patients, nurses completed the anatomy, physical examination and test ordering modules of Master's degree courses in Advanced Practice or equivalent.

INTERVENTION

Participants were assessed by an appropriately trained nurse or a pre-registration house officer. All participants were then reassessed by a specialist registrar in anaesthetics. The specialist registrar rated nurses and house officers' decisions as 'correct,' 'overassessment,' 'underassessment not affecting perioperative management' or 'underassessment possibly affecting perioperative management.' Ratings were checked by expert panels.

OUTCOMES

Competence in history taking, physical examination and ordering of tests.

MAIN RESULTS

Thirteen percent of assessments by nurses and 15% by house officers were judged to be problematic enough to have affected perioperative management (p>0.05, Table 1). House officers were more likely than nurses to order unnecessary tests (24% versus 14%, p<0.05).

Table 1 Pre-operative decisions by nurses or house officers that could have affected perioperative management
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AUTHORS' CONCLUSIONS

If nurses receive adequate training, they can provide pre-operative assessment equivalent to the assessments made by junior doctors and may order fewer tests.