The Research

The research results suggest that there is strong evidence of differences in the likelihood of anesthesia complications by patient characteristics, patient comorbidities, and the procedures being administered, but virtually no evidence that complication rates differ based on anesthesia provider scope of practice or anesthesia delivery model.

Participants represented urban (23%) and rural (77%) practices, as well as office/clinic (31%), hospital (62%) and mixed (7%) practice settings. Research results showed that CRNAs were able to safely and effectively perform fluoroscopic guided LESIs with complication rates similar to physician rates cited in the literature.

This literature review determined that no definitive statement can be made about the possible superiority of one type of anesthesia care over another.

Analysis of seven years of Medicare inpatient anesthesia claims reveals that the change in CMS policy allowing states to opt out of the physician supervision requirement for Certified Registered Nurse Anesthetist reimbursement was not associated with increased risks to patients.

Hospitals that use only CRNAs, or a combination of CRNAs and anesthesiologists, do not have systematically poorer maternal outcomes compared with hospitals using anesthesiologist-only models.

There is no difference in rates of complications between the two types of staffing models: anesthesia provided solely by CRNAs versus solely by physician anesthesiologists. As a result, hospitals and anesthesiology groups may safely examine other variables, such as provider availability and costs, when staffing for obstetrical anesthesia.

The researchers studied the effect of type of anesthesia provider on mortality rates of Medicare patients undergoing eight different surgical procedures. Mortality was compared for physician anesthesiologists working alone, Certified Registered Nurse Anesthetists (CRNAs) working alone, and anesthesia care teams. Observed and predicted values by type of provider did not differ in a statistically significant way. Hospitals without physician anesthesiologists had results similar to hospitals where physician anesthesiologists provided or directed anesthesia care.

The research results from this landmark study show that as the demand for healthcare continues to grow, increasing the number of CRNAs and permitting them to practice in the most efficient delivery models will be key to containing costs while maintaining quality care. Additionally, the researchers confirmed that CRNAs are significantly less costly to educate and train than physician anesthesiologists.

Certified Registered Nurse Anesthetists (CRNAs) correlated with lower-income populations, where anesthesiologists correlated with higher-income populations. Furthermore, CRNAs correlated more with vulnerable populations such as Medicaid-eligible patients. Assuring the population has adequate insurance is one of the hallmark achievements of the Affordable Care Act (ACA). Removing barriers to CRNA scope of practice to maximize CRNA services will facilitate meeting the demand by vulnerable populations after full implementation of the ACA.

Recent research reaffirms that Certified Registered Nurse Anesthetists (CRNAs) are critical to the delivery of anesthesia in the United States and argues persuasively for the removal of barriers—including supervision requirements—that prevent CRNAs and other advanced practice registered nurses (APRNs) from practicing to the full extent of their education and training. Repealing the federal Medicare physician supervision requirement for nurse anesthetists is an important step toward achieving this goal.

In this report, the Institute of Medicine (now the National Academy of Medicine) recommends that nurses should be allowed to practice to the full extent of their education and training, and should become full partners with physicians and other healthcare professionals in redesigning healthcare in the United States.

The research results suggest that recent graduates are well-prepared for entry into practice. While graduates and employers identified opportunities to enhance preparation it may not be sufficient to simply improve education without changing CRNA practice expectations.