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  • Study Shows Practice Restrictions and Physician Supervision Have No Impact on Anesthesia Patient Safety



    Scope of practice (SOP) restrictions and physician supervision requirements for nurse anesthetists have no impact on anesthesia patient safety, according to new research published in the June 2016 issue of the independent, peer-reviewed scientific journal Medical Care. The study, titled “Scope of Practice Laws and Anesthesia Complications,” is the first to focus on the effects of state SOP laws and anesthesia delivery models on patient safety. The study is found here

    Conducted by Virginia-based The Lewin Group, the study also concluded that while state SOP restrictions and physician supervision do not increase anesthesia safety, they do reduce patient access to quality care and increase costs of healthcare services.

    The study examined a database (5.7 million anesthesia cases) that was five times larger than the largest sample used in previous anesthesia outcomes studies. More than 49,000 nurse anesthetists safely provide nearly 40 million anesthetists to patients each year in the United States.

    “The Scope of Practice research in Medical Care is yet another excellent study confirming that CRNAs ensure patient access to safe, cost-effective anesthesia care,” said Juan Quintana, DNP, MHS, CRNA, president of the American Association of Nurse Anesthetists (AANA) and a nine-year veteran of the Air Force Reserve. “The study also lends strong credence to the VHA’s recommendation to use CRNAs and other APRNs to their full scope of practice because our veterans need and deserve timely access to the safest anesthesia care possible.”

    The timing of the study’s publication in Medical Care coincides with publication of the Veterans Health Administration (VHA) proposed rule in the May 25 Federal Register which allows Certified Registered Nurse Anesthetists (CRNAs) and other advanced practice registered nurses (APRNs) to provide care to the full extent of their education and abilities in an effort to reduce long wait times for veterans seeking healthcare, a problem that has challenged the VHA for years. The proposed rule is consistent with recommendations from the National Academies of Medicine (formerly the Institute of Medicine) and backed by the results of an independent assessment of the VHA health system that was ordered by Congress and published in 2015. The rule is currently in a 60-day comment period ending July 25.

    The VHA policy change would allow CRNAs to work “without the clinical oversight of a physician, regardless of state or local law restrictions on that authority.”

    “Despite so much solid evidence to confirm the safety of anesthesia care provided by CRNAs with or without physician supervision, physicians groups nonetheless oppose the VHA’s plan to help our military veterans. Given that the doctors don’t have any evidence of their own to support their arguments, their actions are really quite reckless and selfishly put our nation’s veterans in a most precarious position,” said Quintana.

    The VHA proposal is supported by more than 60 organizations, including AARP, veterans’ groups, healthcare professional organizations including the American Association of Nurse Anesthetists (AANA) and other APRN associations, and 80 Democratic and Republican members of Congress.

    “It’s interesting that the same doctors who argue that they need to be involved in the care of our military veterans don’t insist on being assigned to the front lines during military actions to care for soldiers horribly injured during battle, leaving this up to CRNAs to handle,” said Quintana. “Somehow, in their view, that’s less complicated than caring for veterans stateside. That’s an affront to any man or woman who has ever worn a uniform in service to this country.”
    Comments 16 Comments
    1. jwk's Avatar
      jwk -
      Ah yes, because all good studies come from a retrospective claims analysis.
    1. rbland59's Avatar
      rbland59 -
      Like Silber? And the latest one by that anesthesia resident?? Seriously JWK ... sauce and ganders and such!
    1. jwk's Avatar
      jwk -
      Quote Originally Posted by rbland59 View Post
      Like Silber? And the latest one by that anesthesia resident?? Seriously JWK ... sauce and ganders and such!
      I wonder who paid for this "study"?
    1. AnesRes2014's Avatar
      AnesRes2014 -
      Quote Originally Posted by jwk View Post
      I wonder who paid for this "study"?
      Yup, totally independent and unbiased. No conflicts of interest whatsoever.

      http://www.washingtonpost.com/wp-dyn...072203696.html

      If there's one thing we should all be agreeing on, it's that everyone has an agenda. To pretend otherwise is idiotic.
    1. yankeern's Avatar
      yankeern -
      Quote Originally Posted by AnesRes2014 View Post
      Yup, totally independent and unbiased. No conflicts of interest whatsoever.

      http://www.washingtonpost.com/wp-dyn...072203696.html

      If there's one thing we should all be agreeing on, it's that everyone has an agenda. To pretend otherwise is idiotic.
      Huh. Let's see, anesthesiologist agenda control and money, nothing else. Just like the VA issue, you don't see them complaining about supervision on the front lines do you. Nope. But in the VA in the states where there is control and money involved, you bet.

      Sent from my SM-G935V using Tapatalk
    1. AnesRes2014's Avatar
      AnesRes2014 -
      Quote Originally Posted by yankeern View Post
      Huh. Let's see, anesthesiologist agenda control and money, nothing else. Just like the VA issue, you don't see them complaining about supervision on the front lines do you. Nope. But in the VA in the states where there is control and money involved, you bet.

      Sent from my SM-G935V using Tapatalk
      Not entirely sure what you are arguing, but of course it is about control and money. The world runs on control and money. Do you not think CRNAs (or RNs, or optometrists, or "insert any other group here") are interested in control and money?
    1. Syd's Avatar
      Syd -
      No drastic news or changes…everyone has a place. Some like to practice solo some do not. The options are always there. We should not let government and insurance hacks decide how it will be. All should be aware of their comfort and work level that fits the institution.
    1. Syd's Avatar
      Syd -
      Yes money and control rule…as anyone who spent time at the University knows well. Followed closely by pride and peeking order. As it is "down on the farm" the roosters go to bed at sun set and but the work carries on. Just as a historic note; back in the day; that day before 1985 say… hospitals after 5pm were run by Supervising RN. All codes we initiated by nurse in charge. Labs, X-rays, ordered and interpreted by nurse in charge. EKGs interpreted with the help of "Marriott" -the cardiologist guru of the day. Complete block, Type 1 or 11, all done by the nurses. Sepsis-bowel obstructions-distented bladders-suspected and bleeding bellies; all nurses. The ER did not have a ER doctor most of the time and when they did, he was not to be awoke until after Nurse reviewed patients and determined the need for Doc to arise and treat. Now this seems crazy but training was different, experience counted, and people just can't work more then 24hrs a day. I once viewed a 1940's English film showing "Out Patient Surgery" imagine my surprise. ( no running fluids_NaPentathal direct, total IV anesthesia) Nothing is new only the faces change.
    1. Syd's Avatar
      Syd -
      You are just beginning a long path I hope, in health care. The hardest part is dealing with people..people who are unhappy, unfulfilled. Folks who feel they never reached for a goal they never knew was there can wear on our souls. Remember your raising"…you are a strong nurse with much experience to share in keeping watch over the patient on the table. You must move thru a room full of ego's and bitterness even, to reach the PACU in good shape. And it must be done with kindness, because anyone you meet may need you soon, or you them. Healthcare workers spend 35% of their life on the job, so you are likely to crash on the floor where you stand.Hopefully before the case begins if someone lets you out. Focus on why you are there. If it is for the money and position, try and fake it, pretend you love caring for folks in such a way , they make the trip safe. All aboard _hands and feet inside the ride_ I will be your family and see you safe home.
    1. yankeern's Avatar
      yankeern -
      Quote Originally Posted by AnesRes2014 View Post
      Not entirely sure what you are arguing, but of course it is about control and money. The world runs on control and money. Do you not think CRNAs (or RNs, or optometrists, or "insert any other group here") are interested in control and money?
      Of course I know it is about money and control. It is just sad how ASA uses fear mongering and lies about CRNA, just so they can maintain their gravy train, and make money of the sweat of CRNA backs. I love to hear them say how better they are at providing anesthesia, but the fact is some of them would have difficulty running their own room.

      Sent from my SM-G935V using Tapatalk
    1. jwk's Avatar
      jwk -
      Quote Originally Posted by yankeern View Post
      Of course I know it is about money and control. It is just sad how ASA uses fear mongering and lies about CRNA, just so they can maintain their gravy train, and make money of the sweat of CRNA backs. I love to hear them say how better they are at providing anesthesia, but the fact is some of them would have difficulty running their own room.

      Sent from my SM-G935V using Tapatalk
      Of course it's about money...It's sad how the AANA uses fear mongering and lies about AAs, just so they can maintain their gravy train.
    1. yankeern's Avatar
      yankeern -
      Quote Originally Posted by jwk View Post
      Of course it's about money...It's sad how the AANA uses fear mongering and lies about AAs, just so they can maintain their gravy train.
      That is the most ridiculous statement I have herd in a long time. Nice try there, we make no profit off of AAs so no gravy train there. Your profession was created for one reason, to maintain anesthesiologists gravey train that is all. Of course you always support the ASA because without them you don't exist.

      Sent from my SM-G935V using Tapatalk
    1. jwk's Avatar
      jwk -
      Quote Originally Posted by yankeern View Post
      That is the most ridiculous statement I have herd in a long time. Nice try there, we make no profit off of AAs so no gravy train there. Your profession was created for one reason, to maintain anesthesiologists gravey train that is all. Of course you always support the ASA because without them you don't exist.

      Sent from my SM-G935V using Tapatalk
      If you don't think that the AANA and CRNA's lie through their teeth about AA's and try to prevent expansion of AA practice nationwide, you are totally and utterly clueless. Really.
    1. yankeern's Avatar
      yankeern -
      Quote Originally Posted by jwk View Post
      If you don't think that the AANA and CRNA's lie through their teeth about AA's and try to prevent expansion of AA practice nationwide, you are totally and utterly clueless. Really.
      We don't speed any lie about AAs. We don't have to. Nothing about CRNA and AA training is equal or ever will be. We are taught to practice independent you are taught to be dependent.

      Sent from my SM-G935V using Tapatalk
    1. jwk's Avatar
      jwk -
      Quote Originally Posted by yankeern View Post
      We don't speed any lie about AAs. We don't have to. Nothing about CRNA and AA training is equal or ever will be. We are taught to practice independent you are taught to be dependent.

      Sent from my SM-G935V using Tapatalk
      Like I said - totally and utterly clueless.
    1. ADMIN's Avatar
      ADMIN -
      jwk.

      The AANA has never said anything about AAs which has not been based in facts. Ive read all of their releases. You are FOS.