Nurses no worse than junior doctors in assessing patients before surgery

December 05, 2002

Reform of junior doctors' hours has increased the pressure to use non-medical staff to assess patients before surgery. A study in this week's BMJ finds that appropriately trained nurses perform no worse than pre-registration house officers in preoperative assessment, although neither group performed particularly well.

Researchers identified 1,874 patients attending four NHS hospitals for assessment before surgery. House officers assessed 926 patients and appropriately trained nurses assessed 948 patients. A specialist registrar examined each patient after the nurse or house officer to judge their performance.

Patients faced a one in seven chance of a house officer failing to detect something that might affect their management and a one in eight chance of an appropriately trained nurse doing the same.

Nurses were judged to be non-inferior to house officers, although there was variation among them in terms of the quality of history taking. House officers ordered nearly twice as many unnecessary tests as nurses.

For most hospitals in the United Kingdom there will not be enough house officers to carry out pre-operative assessment, say the authors. However, they conclude that some pre-operative assessment is necessary for their training, and so they cannot be entirely replaced by nurses, even if this is seen as a role within which nurses could develop a career.
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BMJ

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