A pilot randomised controlled trial of medical versus nurse clerking for minor surgery

Abstract

Background-Nurse led clerking is currently practiced in a growing number of UK centres, but there is a paucity of evidence to underpin the safety of this innovation. Aim-To assess the safety of nurse led clerking in paediatric day case and minor surgery. Methods-Children aged 3 months to 15 years were randomly assigned to clerking by either a nurse or a senior house oYcer (SHO) (resident). All children were then independently reassessed by a specialist registrar anaesthetist to provide a "gold standard" against which practitioner performance could be judged. Results-In 60 children studied, nurses identified a significantly greater proportion of the detectable abnormalities present in the sample (p = 0.16). This difference is attributable to nurses' greater accuracy in history taking (p = 0.04); no conclusions regarding the comparability of nurses' and SHOs' skills in physical examination can be derived from the current study. Conclusion-Evidence attests to the likelihood of nursing having superior skills in history taking to SHOs. Exploration of nursing safety in undertaking physical examination, however, requires the conduct of a large scale equivalence study. Only then can conclusions be drawn as to whether nurse led physical assessment oVers children a standard of care equivalent to that which they currently receive from SHOs.

Patient satisfaction after removal of skin lesions

“…The quality, communication and cooperation between surgeon and nurse on one side and the patient on the other have been reported in a few studies to play an important role. [29][30][31][32][33][34][35] We think that this should be considered seriously and that arrangements should be made to better maintain the privacy of the patient during the surgery.…”

Clinical and education implications of shift work

“…Studies find that nurse-led PACs are equally effective at detecting undiagnosed or poorly controlled medical problems (Koay & Marks, 1996;Whiteley et al, 1997;Rushforth et al, 2000) and, if broadly introduced, PRHOs would only be required to examine patients and obtain consent on the day of admission.…”

Data recording aids in acute admissions

“…The pro-forma, however, uses more paper that frequently contains sparse information, causing bulkier patient-medical notes, often leading to binding problems and two or more volumes. Introducing pro-forma is associated with data capture improvements in non-acute settings regardless of training (Rushforth et al, 2000;Whiteley et al, 1997). Pro-forma guide the clinician and reduce the likelihood that important admission record and handover information are omitted (Ho et al, 2005;Goodyear and Lloyd, 1995;Ferran et al, 2008).…”