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Research

Effectiveness of nurse delivered endoscopy: findings from randomised multi-institution nurse endoscopy trial (MINuET)

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b231 (Published 10 February 2009) Cite this as: BMJ 2009;338:b231
  1. John Williams, professor 1,
  2. Ian Russell, professor and director 2,
  3. Dharmaraj Durai, consultant gastroenterologist3,
  4. Wai Yee Cheung, senior lecturer1,
  5. Amanda Farrin, director and principal statistician (health sciences division)4,
  6. Karen Bloor, senior research fellow5,
  7. Simon Coulton, reader in health services research6,
  8. Gerry Richardson, senior research fellow7
  1. 1Centre for Health Information, Research and Evaluation, School of Medicine, Swansea University, Swansea SA2 8PP
  2. 2North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd
  3. 3Wishaw General Hospital, Wishaw, Lanarkshire
  4. 4Clinical Trials Research Unit, University of Leeds, Leeds
  5. 5Department of Health Sciences, University of York, York
  6. 6Centre for Health Services Studies, University of Kent, Canterbury, Kent
  7. 7Centre for Health Economics and Hull York Medical School (HYMS), University of York, York
  1. Correspondence to: J G Williams j.g.williams{at}swansea.ac.uk
  • Accepted 24 October 2008

Abstract

Objective To compare the clinical effectiveness of doctors and nurses in undertaking upper and lower gastrointestinal endoscopy.

Design Pragmatic trial with Zelen’s randomisation before consent to minimise distortion of existing practice.

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

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

Interventions 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.

Main outcome measures 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.

Trial registration International standard RCT 82765705

Footnotes

  • We gratefully acknowledge the contribution of the following people to the conduct of this study: Faiz Ali, video assessor, Neath Port Talbot Hospital; Anne Burton, research secretary, University of York; Gaynor Demery, personal assistant, Swansea University; Lakshmi Sakthi Durai, endoscopy report quality, diagnosis and drugs data collection; David Ford, business manager, Swansea University; Fiona Fylan, reader in health psychology, Leeds Metropolitan University; Eleanor Gregory, clerical officer, Swansea University; A Pal, video assessor, St Mark’s Hospital, London; Eadala Praveen, video assessor, Morriston Hospital, Swansea; A Qureshi, video assessor, Northwick Park Hospital, London; Mesbahur Rahman, video assessor, Neath Port Talbot Hospital; Stephen Roberts, senior lecturer, Swansea University; Mark Sculpher, professor of health economics, University of York; Anne Seagrove, clerical officer, Swansea University, Brian Saunders, video assessor, St Mark’s Hospital, London; Siwan Thomas Gibson, video assessor, St Mark’s Hospital, London; Valerie Wadsworth, data manager, University of York.

  • Local collaborators

  • Flexible sigmoidoscopy

  • Ayr Hospital: C Wilson (lead clinician), L McNaughton (nurse endoscopist); Crosshouse Hospital, Kilmarnock: C Morran, K Linton and S Mair; Darlington Memorial Hospital: K Gunning, C Westwood; Gartnavel General Hospital, Glasgow: P R Mills, I Drummond; George Eliot Hospital, Nuneaton: G Mathew, A Reynolds; Kettering General Hospital: A Hussain, T Brooks; Leicester Royal Infirmary: B J Rathbone, B Litchfield; Royal Albert Edward Infirmary, Wigan: P W Bliss, P Dereszkiewicz; Monklands Hospital, Airdrie: R J Holden, L Wood; City General Hospital, Stoke on Trent: C Hall, D Latham; Northampton General Hospital: D C Hunter, S Hargreaves and C Sombach; Oldchurch Hospital, Romford: D Khoo, J Ward; Queen Alexandra Hospital, Portsmouth: A Senapati, A Cantelo-Jones; Queen’s Medical Centre, Nottingham: J Scholefield, M Castle; Rotherham General Hospital: R B Jones, J D’Silva; Royal Glamorgan Hospital, Pontypridd: P Davies, J West; St George’s Hospital, London: R J Leicester, J Ho; Victoria Hospital, Kirkcaldy: G Birnie, A Macdonald; Royal Sussex County Hospital, Brighton: S Cairns, J Grant; Russells Hall Hospital, Dudley: A N Hamlyn, L Wood.

  • Oesophagogastroduodenoscopy

  • Crosshouse Hospital, Kilmarnock: C Morran, K Linton and S Mair; Leicester Royal Infirmary: B J Rathbone, B Litchfield; Royal Albert Edward Infirmary, Wigan: P W Bliss, P Dereszkiewicz; Monklands Hospital, Airdrie: R J Holden, L Wood; Queen’s Medical Centre, Nottingham: S Ryder, B Pick; Royal Shrewsbury Hospital: M Smith, L Bottomley; St John’s Hospital, Livingston: A J K Williams, D McDonald; University Hospital Aintree, Liverpool: N Krasner, R Nicholson and J McPhillips; Victoria Hospital, Kirkcaldy: G Birnie, A Macdonald.

  • Contributors: JW led the trial team, was principal author, and is guarantor. IR contributed to the design and implementation of the trial and drafting the paper. DD developed, validated, and applied the method of assessing the video recordings, validated the gastrointestinal endoscopy satisfaction questionnaire, collected and analysed clinical data, and contributed to drafting the paper. WYC validated both questionnaires. AF was responsible for the design, conduct and interpretation of the statistical analysis, and contributed to the overall design and implementation of the trial and drafting the paper. KB contributed to analysis and drafting of the paper. SC developed, validated, and managed the main database. GR contributed to drafting of the paper. All authors reviewed successive drafts of both papers.

  • Funding: The study was funded by the NIHR Evaluation Trials and Studies Coordinating Centre.

  • Competing interests: None declared.

  • Ethical approval: The study was approved by the Multicentre Research Ethics Committee for Wales and informed consent was given by all patients. Participating centres also obtained approval from their own local research ethics committees.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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