title: Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial.
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.
  
  
  METHODS
  Randomised controlled equivalence/non-inferiority trial.
  
  
  METHODS
  Four NHS hospitals in three trusts. Three of the four were teaching hospitals.
  
  
  METHODS
  All patients attending for assessment before general anaesthesia for general, vascular, urological, or breast surgery between April 1998 and March 1999.
  
  
  METHODS
  Assessment by one of three appropriately trained nurses or by one of several preregistration house officers.
  
  
  METHODS
  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.
authors.affiliation: University Surgery, University of Southampton School of Medicine, Southampton General Hospital, Southampton SO16 6YD.
authors.forename: Helen
authors.initials: H
authors.lastname: Kinley
authors.forename: Carolyn
authors.initials: C
authors.lastname: Czoski-Murray
authors.forename: Steve
authors.initials: S
authors.lastname: George
authors.forename: Chris
authors.initials: C
authors.lastname: McCabe
authors.forename: John
authors.initials: J
authors.lastname: Primrose
authors.forename: Charles
authors.initials: C
authors.lastname: Reilly
authors.forename: Richard
authors.initials: R
authors.lastname: Wood
authors.forename: Paula
authors.initials: P
authors.lastname: Nicolson
authors.forename: Caroline
authors.initials: C
authors.lastname: Healy
authors.forename: Susan
authors.initials: S
authors.lastname: Read
authors.forename: John
authors.initials: J
authors.lastname: Norman
authors.forename: Ellen
authors.initials: E
authors.lastname: Janke
authors.forename: Hameed
authors.initials: H
authors.lastname: Alhameed
authors.forename: Nick
authors.initials: N
authors.lastname: Fernandes
authors.forename: Eileen
authors.initials: E
authors.lastname: Thomas
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004739:England; D006779:Hospitals, Public / Q000592:standards*; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D008487:Medical History Taking / Q000592:standards; D008505:Medical Staff, Hospital / Q000592:standards; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000592:standards*; D017063:Outcome Assessment, Health Care; D010808:Physical Examination / Q000592:standards; D011300:Preoperative Care / Q000451:nursing*; D011787:Quality of Health Care; D012017:Referral and Consultation