Thursday, August 5, 2010

Anesthesia: CRNA or Anesthesiologist, Who Provides the Best Quality of Care?

Health Affairs, (the preeminent peer-reviewed journal covering health policy), has released important new research regarding the quality of anesthesia care.

This may not come as a surprise to most inside the medical profession, but may surprise those outside medicine--- the study shows that there are NO differences in patient outcomes, when anesthesia services are provided either by CRNAs (Certified Registered Nurse Anesthetists), or by physician anesthesiologists, or by CRNAs supervised by physicians.

According to the study, the CRNA's quality of anesthesia care is as good as it gets. The research, titled "No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians," is out in print in the August issue of Health Affairs.

Conducted by RTI International, a leading USA research institute, the study results send a strong message to the healthcare community, policy makers, as well as patients who need anesthesia services, and their families.

The researchers were Brian Dulisse, a health economist at the Research Triangle Institute, in Waltham, Massachusetts, and Jerry Cromwell, a senior fellow in health economics at the Research Triangle Institute.

This research, as I said above, is no news to many inside medicine. In 2001, the Centers for Medicare and Medicaid Services (CMS) allowed states to opt out of the requirement for reimbursement that a surgeon or anesthesiologist oversee the provision of anesthesia by certified registered nurse anesthetists.

By 2005, fourteen states had exercised this option. An analysis of Medicare data (for 1999–2005) finds no evidence that opting out of the oversight requirement resulted in increased inpatient deaths or complications. Based on our findings, we recommend that CMS allow certified registered nurse anesthetists in every state to work without the supervision of a surgeon or anesthesiologist.

In fact, the US military has always used CRNA's, seeing no need to employ expensive and redundant physician anesthesiologists--- who typically stand by but themselves rarely even perform actual anesthesia--- which is almost always administered by CRNA's.

So, the message for hospitals, wishing to save money while ensuring quality of anesthesia care, is this--- that CRNAs, practicing without physician supervision, provide safe, cost-effective, high-quality, anesthesia.

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