This is an excerpt from the AANA website:


Synopsis of Available Published Information Comparing CRNA and Anesthesiologist Patient Anesthesia Outcomes

Patients and healthcare institutions have an interest in information concerning the quality of care given by healthcare providers.
Nurse anesthetists have been providing quality anesthesia care in the United States for more than 100 years. In administering more than 65 percent of the anesthetics given annually, CRNAs have compiled an enviable safety record. No studies to date that have addressed anesthesia care outcomes have demonstrated that there is a difference in patient outcomes based on the type of provider.


1. In a study mandated by the U.S. Congress and performed by the National Academy of Sciences, National Research Council, the report to Congress states: "There was no association of complications of anesthesia with the qualifications of the anesthetist or with the type of anesthesia." (House Committee Print No. 36, Health Care For American Veterans, page 156, dated June 7,1977.)


2. A study concerning anesthetic-related deaths from 1969-1976 by Albert Bechtoldt, Jr. and the Anesthesia Study Committee, published in the North Carolina Medical Journal in April 1981, stated on page 257 that: "Therefore, when we calculated the incidence of anesthetic-related deaths for each group which administered the anesthetic (Figure 2), we found that the incidence among the three major groups (the CRNA, the anesthesiologist and the combination of CRNA and anesthesiologist) to be rather similar. Although the CRNA working alone accounted for about half of the anesthetic-related deaths, the CRNA working alone also accounted for about half of the anesthetics administered."


3. The Stanford Center for Health Care Research conducted a 17-hospital intensive study of institutional differences. A report of the study stated that: "Thus, using conservative statistical methods, we concluded that there were no significant differences in outcomes between the two groups of hospitals defined by type of anesthesia provider." See Forrest WH Jr. "Outcome-The Effect of the Provider," at page 137 in Hirsh RA, et al (eds): Health Care Delivery in Anesthesia. 1980. Philadelphia: George F. Stickley Company.


4. A 1994 legislatively mandated study by the Minnesota Department of Health looked at the provision of anesthesia services by anesthesiologists and certified nurse anesthetists. The resulting assessment of the existing studies determined that there are no studies, either national or Minnesota- specific, that conclusively show a difference in patient outcomes based on type of anesthesia provider.


5. The Center for Health Economics Research (CHER) completed a report in January 1988 for the Health Care Financing Administration (HCFA). The purpose of the report was to assist HCFA in the development of a fee schedule for CRNA direct Medicare reimbursement, effective January 1, 1989. CHER is an independent Boston-area based research organization that analyzes and evaluates federal health programs. As part of the report, CHER conducted a review of the literature concerning anesthesia quality. CHER addressed the question of whether the quality of anesthesia care varies by the type of anesthesia provider. As part of its literature review, CHER reviewed three studies which have explicitly examined anesthesia outcomes by provider type. The CHER researchers concluded that "none of the studies detected significant differences in anesthesia outcomes among nurse anesthetists versus anesthesiologists." The CHER researchers stated that anesthesia outcomes between CRNAs and anesthesiologists "have not been shown to differ."


The U.S. House of Representatives Committee on Armed Services Report on H.R.1748, the Department of Defense Authorization Act for Fiscal Year 1988-89, commented on a proposed change in the supervision of nurse anesthetists in the military services that would require anesthesiologist supervision. The committee stated that: "From the quality of care standpoint, the committee is not aware of any data that suggests that nurse anesthetists need a higher level of supervision than they currently have. If such data exists, the committee would be very interested to review it."


At pages 208 to 209, the report stated that: "The committee understands that the current practice in the civilian, as well as military, medical care systems is that a nurse anesthetist must be supervised by a physician. Under the change proposed within the military, a nurse anesthetist would be required to be supervised by an anesthesiologist.


"The committee is extremely skeptical that such a policy change makes sense from a patient care, quality of care or medical readiness standpoint. In terms of patient care, the requirement that an anesthesiologist supervise every anesthetist would mean that many anesthesiologists would be forced to provide less patient care. Some small hospitals that currently have only one nurse anesthetist and no anesthesiologist would lose their anesthesia capability altogether under this proposal."


In concluding the discussion of this subject, the House committee said that the adoption of a change in policy that would require anesthesiologist supervision of nurse anesthetists must be supported by compelling reasons, with full explanation and supporting data.


The practice of anesthesia has become safer in recent years due to improvements in pharmacological agents and the introduction of sophisticated technology. Recent studies have shown a dramatic reduction in anesthesia mortality rate to approximately 1 per 250,000 anesthetics.


In 1990, the Center for Disease Control (CDC) intended to conduct a research study on morbidity and mortality in anesthesia. Following a review of the anesthesia data, the CDC concluded that morbidity and mortality in anesthesia was too low to warrant the study.


In a 1988 book, Mark Wood of the St. Paul Fire and Marine Insurance Company summarized a St. Paul study of its anesthesia-related claims. St. Paul studied the leading medical liability allegations that St. Paul-insured anesthesiologists and CRNAs reported between 1981 and 1985. The data consisted of all claims, including pending and closed claims. St. Paul concluded that "nurse anesthetist loss experience is very similar to that of anesthesiologists..." See Wood, MD, "Monitoring Equipment and Loss Reduction: An Insurer's View," in Gravenstein JS, Holzer JF (eds): Safety and Cost Contained in Anesthesia. 1988. Stoneham, Mass.: Butterworth Publishers.


From 1988 to 1995, St. Paul has returned nearly $24,000,000 in premiums to it's insured CRNAs because the loss experience was substantially better than St. Paul originally predicted. Further, St. Paul stated in a July 1995 publication: The St. Paul Medical Services Nurse Anesthetist Update, that "nurse anesthetists insured by St. Paul will experience an average countrywide 7 percent decrease in their medical professional liability insurance rates in 1995.


AANA General Counsel Gene A. Blumenreich of Nutter, McClennen and Fish, LLP, Boston, Massachusetts has concluded that while the fact that there is no difference regarding the quality of care rendered by anesthesiologists and CRNAs "may be surprising to the less knowledgeable, an understanding of the nature of anesthesia would lead one to expect this. The vast majority of anesthesia-related accidents have nothing to do with the level of education of the provider." Blumenreich GA, Wolf BL. 1986. "Restrictions on CRNAs imposed by physician-controlled insurance companies." AANA Journal 54:6:538-539.


The most common anesthesia accidents are lack of oxygen supplied to the patient (hypoxia), intubation into the esophagus rather than the trachea and disconnection of oxygen supply to the patient. All of these accidents result from lack of attention to monitoring the patient, not lack of education. In fact, the Harvard Medical School standards in anesthesia are directed toward monitoring, which reiterates the basic point: Most anesthesia incidents relate to lack of attention to monitoring the patient, not lack of education.


As Mr. Blumenreich has stated: "Anesthesia seems to be an area where, beyond a certain level, outcome is only minimally affected by medical knowledge but is greatly affected by factors such as attention, concentration, organization and the ability to function as part of a team; factors toward which all professions strive but which no profession may claim a monopoly." Id.


CRNAs offer a cost-effective alternative to all-physician care in the field of anesthesia. Anesthesia is an appropriate specialty for either nurses or physicians. The evidence to date is compelling and comprehensive that CRNAs provide safe, quality anesthesia care. Patient outcome is similar regardless of whether the anesthesia provider is a CRNA or an anesthesiologist.

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