A randomised controlled trial to compare a nurse practitioner to medical staff in the preparation of patients for diagnostic cardiac catheterisation: the study of nursing intervention in practice (SNIP).
BACKGROUND
A number of initiatives have employed nurses in roles traditionally associated with the medical profession but few have been evaluated in prospective randomised studies. This paper reports the results of a randomised controlled trial to assess the performance of a nurse practitioner (NP), trained to prepare patients for diagnostic cardiac catheterisation.


METHODS
Eligible and consenting patients were randomised to preparation by either the NP or junior medical staff (JMS). The safety outcome measure was the rate of in-hospital major adverse clinical events including death, myocardial infarction and emergency bypass coronary surgery. Other outcome measures included rate of minor adverse events, cardiologist assessment of case preparation and presentation, patient satisfaction and duration of pre-admission clinic.


RESULTS
From April 1997 to May 1998 a series of 355 patients scheduled for elective, day-case, diagnostic cardiac catheterisation were screened. Of these, 345 patients were eligible for the study. A total of 339 patients consented to participate and were randomised. Major adverse clinical events occurred in 0/175 (0%) patients in the NP group and 2/161 (1.2%) patients in the JMS group. (Risk difference = -1.2%, upper boundary of the 95% confidence interval = +2.0%) The cardiologist's evaluation that the patient's preparation was acceptable was high in both groups: NP group 98.3% vs. JMS group 98.8%: P = 1.0). Patient satisfaction, assessed by questionnaire, was greater in the NP group (P = 0.04). The median duration of the pre-admission clinic visit was lower in the NP group 165 min vs. 185 min in the JMS group, P = 0.01).


CONCLUSIONS
The preparation of patients for diagnostic cardiac catheterisation can be safely performed by an appropriately trained NP. This approach may be associated with improved patient satisfaction and reduced clinic duration times.
Stables
R H
RH
Clinical Trials and Evaluation Unit, The Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK.
Booth
J
J
Welstand
J
J
Wright
A
A
Ormerod
O J M
OJ
Hodgson
W R
WR
D006328:Cardiac Catheterization / Q000009:adverse effects / Q000451:nursing / Q000523:psychology / Q000592:standards*; D002983:Clinical Competence / Q000592:standards; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000592:standards*; D009722:Nurse Practitioners / Q000193:education / Q000592:standards*; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011300:Preoperative Care / Q000379:methods / Q000451:nursing* / Q000523:psychology / Q000592:standards*; D011446:Prospective Studies; D012449:Safety; D011795:Surveys and Questionnaires; D016896:Treatment Outcome