Patients Not Harmed from Unsupervised Nurse Anesthetists

Allowing certified registered nurse anesthetists (CRNAs) to provide anesthesia without physician supervision resulted in no evidence of increased inpatient deaths or complications, according to a new study.

Researchers at the Research Triangle Institute (RTI; Waltham, MA, USA) conducted an analysis of U.S. Medicare data for 1999-2005, and used inpatient and carrier data to study inpatient mortality and complications. Of 481,440 hospitalizations, 68,744 were in U.S. states where physician supervision of anesthesia was not required by law. The researchers found that allowing CRNAs to work independently without oversight by an anesthesiologist or surgeon had little or no effect on mortality and morbidity rates. The researchers therefore recommended that the Centers for Medicare & Medicaid Services (CMS; Baltimore, MD, USA) permit the 37,000 nurse anesthetists registered in the United States to work independently, without first requiring state governments to formally petition for an exemption, as has already been done by 14 U.S. states due to a short supply of anesthesiologists, especially rural areas. The study was published in the August 2010 issue of Health Affairs.

"Despite the shift to more anesthetics performed by nurse anesthetists, no increase in adverse outcomes was found; in fact, declining mortality was the norm. The mortality rate for the nurse anesthetist solo group was lower than for the anesthesiologist solo group,” concluded study authors Brian Dulisse, Ph.D., and Jerry Cromwell, Ph.D., health economists at RTI. "These results do not support the hypothesis that allowing states to opt out of the supervision requirement resulted in increased surgical risks to patients. Nor do the results support the claim that patients will be exposed to increased risk as a consequence of more nurse anesthetists' practicing without physician supervision.”

"Since the late 1990s, we've been on record calling for the elimination of supervision for nurse anesthetist services,” said Paul Santoro, CRNA, M.S., president-elect of the American Association of Nurse Anesthetists (AANA; park Ridge, IL, USA), which funded the study. "This antiquated regulation places undue costs on the healthcare system. Local institutions should be free to decide for themselves. This study confirms our position and is supported by several previous studies.”

"The Health Affairs study is an advocacy manifesto masquerading as science and does a disservice to the public. It makes dangerous public policy recommendations on the basis of inadequate data, flawed analysis, and distorted facts,” scathingly responded to the report the American Society of Anesthesiologists (ASA; Park Ridge, IL, USA).

Related Links:
Research Triangle Institute
Centers for Medicare & Medicaid Services
American Association of Nurse Anesthetists
American Society of Anesthesiologists