Practice Restrictions, Physician Supervision Have No Impact on Anesthesia Patient Safety

Physician supervision requirements and scope of practice (SOP) restrictions for nurse anesthetists have no impact on anesthesia patient safety, claims a 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. 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 anesthetics 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."

"Scope of Practice Laws and Anesthesia Complications" was funded by the AANA Foundation.

Source-Newswise