CRNAs Are As Beneficial As Anesthesiologists, Study Shows
By Christina Orlovsky, senior writer
When it comes to safety in an obstetric setting, new research has found that certified registered nurse anesthetists (CRNAs) provide an equal benefit to their physician counterparts.
In a study that appeared earlier this year in the journal Nursing Research, Daniel Simonson, CRNA, MHPA, chief anesthetist and managing partner of The Spokane Eye Surgery Center, in Spokane, Washington, released findings that indicated that there was no difference in complication rates between hospitals that used only CRNAs in cesarean section anesthesia and those that used only anesthesiologists.
The retrospective analysis studied 134,806 patients, of which 33,236 were treated at CRNA-only hospitals and 101,570 at anesthesiologist-only facilities in the state of Washington. The overall anesthetic complications totaled 965, with 17 deaths. Of those, the CRNA-only complication rate was 0.58 percent; the anesthesiologist-only rate was 0.76 percent.
Although the study was conducted solely in the obstetric unit, Simonson explained that the findings reveal farther-reaching conclusions.
“The most important conclusions of this study were that OB anesthesia is extremely safe and that we could find no difference in safety whether or not hospitals were staffed only by CRNAs or only by anesthesiologists,” he said. “I think it makes a very clear statement that hospitals may choose to use CRNAs practicing on their own without anesthesiologist supervision as a cost-effective alternative to other provider arrangements.”
Simonson added that OB patients were selected for several reasons.
“The patients are all of the same sex and within a relatively narrow range of ages, and are undergoing a fairly uniform surgical procedure. Thus the effect of anesthesia staffing on outcome is more easily detected,” he said.
“Although this study looks only at C-sections, the implications are clear: CRNAs provide safe and effective anesthesia care.”
Simonson further explained that the research should help CRNAs earn greater appreciation in the medical communication.
“For many years there has been a push by the American Society of Anesthesiologists to restrict the practice of nurse anesthetists. Despite our ability to practice without medical direction by anesthesiologists in all 50 states and our 120-year history of providing quality care, they have tried to insist that CRNAs should work only under the medical direction of an anesthesiologist—and even then, at only a one-to-two ratio. This study should help put an end to those types of pronouncements,” he said.
“It is obvious from over 12 years of data on 135,000 cesarean sections that CRNAs practicing without medical direction by anesthesiologists are just as safe and provide the same quality of care. We CRNAs would like to see anesthesiologists work together with us to expand the sphere of influence of anesthesia in alleviating the pain and discomfort of patients. CRNAs, because of their nursing background, bring expertise to the practice of anesthesia that is not available from the medical model. That is probably why nurses have been delivering anesthesia since the 1880s and even earlier,” Simonson concluded.
“Anesthesia involves caring for patients, not curing them, and thus benefits greatly from the nursing model of care,” he said. “Together with our physician colleagues we can now move forward to a joint model of anesthesia practice that incorporates the best of both disciplines and allows our expertise to be put to its safest, highest quality and most efficient use—which is the only way was can meet the growing demands of our health care system.”
For more information, visit the Web site of the American Association of Nurse Anesthetists.
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