Help protect anesthesiology!

[funk74]

There is a project underway by Nurses at the VA to undermine the best care of our veterans. In the newly proposed VHA Nursing Handbook, they have outlined a plan for advanced practice nurses to practice anesthesiology independently. They are trying to abandon the Anesthesia team based model that is lead by physicians.

Please take 2 minutes to have your voice heard and pass this message on to your friends and family before it is too late.

Please submit comments here: www.safevacare.org

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[TeslaCoil]

Didn't congress already shoot this down in the past year?

 

[funk74]

No. It's still under the comment period right now and why getting the word out is important.

 

[sevoflurane]

Very important.

 

[criticalelement]

No. It's still under the comment period right now and why getting the word out is important.

where do you lodge a comment?

 

[criticalelement]

forget it i got it..

Is that the official website for comments?

 

[TeslaCoil]

Had this up on FB all day got a strong response...

 

[criticalelement]

Had this up on FB all day got a strong response...

good job. Continue to post it everywhere on social media Twitter, vine, etc..

 

[aneftp]

Issue is as long as Crna independent practice can "punt" difficult cases from rural hospital to other hospitals. It will be very hard to prove "safety"

Also remember Crna in military. Claiming to be safe. Again. Dealing with mainly healthy patient. Hard to mess up anesthesia dealing with mainly ASA 1 population under age 45. (Once they hit 20 years of service they "retire"). Tell me if you ever seen a 350 plus pounder BMI greater than 50 in active military service. They just simply don't exist cause u have to pass certain physical activity standards to go into service. Plus u can't sue in military. It will be extremely hard to prove crnas are "unsafe".

Same thing will happen in VA. Hard to sue providers in VA. Sure VA does settle malpractice cases but usually the Feds eat the cost and the provider escapes free of having their name on the record.

The facts unfortunately are that 70-80% of crnas can do "solo" anesthesia on 80-90% of patients safety. The AANA knows this and can completely sckew public perception towards what they want to accomplish

It's the sick peds. Sick hearts etc. but they can just punt those cases to MDs

 

[pgg]

Also remember Crna in military. Claiming to be safe. Again. Dealing with mainly healthy patient. Hard to mess up anesthesia dealing with mainly ASA 1 population under age 45. (Once they hit 20 years of service they "retire"). Tell me if you ever seen a 350 plus pounder BMI greater than 50 in active military service. They just simply don't exist cause u have to pass certain physical activity standards to go into service. Plus u can't sue in military. It will be extremely hard to prove crnas are "unsafe".

While you're right that proof won't be forthcoming from military hospitals, those reasons aren't quite right.

At smaller, low volume military hospitals the patient acuity and case complexity is indeed very low - think of a surgicenter with better screening than most.

But the majority of patients at the larger military hospitals are retirees and family members of active duty personnel. I'd guess 80%+ of our patients are NOT active duty military. Retirees and family members are not covered by Feres Doctrine; they can and do sue. The retirees can be very unhealthy. These hospitals do neurosurgery, pump cases, complicated OB with NICUs and the associated neonatal OR trips, etc.

The reason CRNAs aren't bumping off patients left and right at military hospitals isn't because there are no sick patients; it's because the sick patients are done by anesthesiologists, and the CRNAs aren't really practicing independently. The daily assignments are made by an anesthesiologist and cases are triaged so that sick patients and complex cases go to an anesthesiologist (+/- a resident). CRNAs are required to consult with an anesthesiologist for ASA 3+ patients ... though in truth 90%+ of the ASA 3 patients they see are elective total joints who get blocks from an anesthesiologist followed by a spinal, ie soft ASA 3s.

Additionally, military CRNAs are, on average, substantially better than civilian trained ones. Their training is better; they get better candidates in the first place; and SRNAs don't pay tuition so they can be failed and kicked out of the program if they do poorly.

 

[criticalelement]

Additionally, military CRNAs are, on average, substantially better than civilian trained ones. Their training is better; they get better candidates in the first place; and SRNAs don't pay tuition so they can be failed and kicked out of the program if they do poorly.

oh so not true.. I dont agree at all that crnas in military are better than civilian ones

 

[aneftp]

While you're right that proof won't be forthcoming from military hospitals, those reasons aren't quite right.

At smaller, low volume military hospitals the patient acuity and case complexity is indeed very low - think of a surgicenter with better screening than most.

But the majority of patients at the larger military hospitals are retirees and family members of active duty personnel. I'd guess 80%+ of our patients are NOT active duty military. Retirees and family members are not covered by Feres Doctrine; they can and do sue. The retirees can be very unhealthy. These hospitals do neurosurgery, pump cases, complicated OB with NICUs and the associated neonatal OR trips, etc.

The reason CRNAs aren't bumping off patients left and right at military hospitals isn't because there are no sick patients; it's because the sick patients are done by anesthesiologists, and the CRNAs aren't really practicing independently. The daily assignments are made by an anesthesiologist and cases are triaged so that sick patients and complex cases go to an anesthesiologist (+/- a resident). CRNAs are required to consult with an anesthesiologist for ASA 3+ patients ... though in truth 90%+ of the ASA 3 patients they see are elective total joints who get blocks from an anesthesiologist followed by a spinal, ie soft ASA 3s.

Additionally, military CRNAs are, on average, substantially better than civilian trained ones. Their training is better; they get better candidates in the first place; and SRNAs don't pay tuition so they can be failed and kicked out of the program if they do poorly.

Again. You state the point I state and the AANA goes along with this.

There is a lot of cherry picking going on. Some people are assigned sicker cases (anesthesiologists).

It's political suicide (frankly not feasible) for ASA just to demand a safety study with real live patients exposing patients to weaker anesthesia "providers".

What patient or family member would ever sign up for that double blind trial?

 

[pgg]

oh so not true.. I dont agree at all that crnas in military are better than civilian ones

Meh, in my experience, on average they are.

Some of the strip-mall CRNA puppy mills are really putting out dangerous graduates. They will train anyone and graduate anyone if the tuition check clears.

 

[IlDestriero]

We had some area SRNAs when I was at NMC San Diego. The Navy CRNAs were miles ahead of those dunces. They were really scary and needed close supervision. When I left they were talking about dumping them. They were there for OB electives.