Effectiveness of nurse delivered endoscopy: findings from randomised multi-institution nurse endoscopy trial (MINuET).
OBJECTIVE
To compare the clinical effectiveness of doctors and nurses in undertaking upper and lower gastrointestinal endoscopy.


METHODS
Pragmatic trial with Zelen's randomisation before consent to minimise distortion of existing practice.


METHODS
23 hospitals in the United Kingdom. In six hospitals, nurses undertook both upper and lower gastrointestinal endoscopy, yielding a total of 29 centres.


METHODS
67 doctors and 30 nurses. Of 4964 potentially eligible patients, we randomised 4128 (83%) and recruited 1888 (38%) from July 2002 to June 2003.


METHODS
Diagnostic upper gastrointestinal endoscopy and flexible sigmoidoscopy, undertaken with or without sedation, with the standard preparation, techniques, and protocols of participating hospitals. After referral for either procedure, patients were randomised between doctors and nurses.


METHODS
Gastrointestinal symptom rating questionnaire (primary outcome), gastrointestinal endoscopy satisfaction questionnaire and state-trait anxiety inventory (all analysed by intention to treat); immediate and delayed complications; quality of examination and corresponding report; patients' preferences for operator; and new diagnoses at one year (all analysed according to who carried out the procedure).


RESULTS
There was no significant difference between groups in outcome at one day, one month, or one year after endoscopy, except that patients were more satisfied with nurses after one day. Nurses were also more thorough than doctors in examining the stomach and oesophagus. While quality of life scores were slightly better in patients the doctor group, this was not statistically significant.


CONCLUSIONS
Diagnostic endoscopy can be undertaken safely and effectively by nurses.


BACKGROUND
International standard RCT 82765705.
Williams
John
J
Centre for Health Information, Research and Evaluation, School of Medicine, Swansea University, Swansea SA2 8PP.
Russell
Ian
I
Durai
Dharmaraj
D
Cheung
Wai Yee
WY
Farrin
Amanda
A
Bloor
Karen
K
Coulton
Simon
S
Richardson
Gerry
G
D001007:Anxiety / Q000209:etiology; D003362:Cost-Benefit Analysis; D016099:Endoscopy, Gastrointestinal / Q000379:methods / Q000451:nursing*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000451:nursing; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D006113:United Kingdom; D014741:Video Recording