CRNA + other midlevel providers....presentation

[SxRx]

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Hello everyone,

I'm giving a presentation to my med student colleagues about various midlevel providers and how they impact physician practices. I'm doing some research here and there online to get some journal articles about this issue and thought perhaps it'd be good to have some of you point me in the right direction in terms of which article may be good to read on this topic. Any links to journal articles or online articles would be appreciated.

It seems to me that from reading some postings regarding this matter, CRNAs claim through a study sponsored by the CRNAs that there is no safety difference between MDs and CRNAs. Whether that is true or not I'm not sure. But, it seems that at least for me that's only a part of the issue. We all want to protect our scope of practice and it's not different for anesthesiologists. I was reading the AANA website. It makes sure it addresses how they are more economical than the MDs, safety is equal to delivery by MDs and they got started because the surgeons requested that they have a dedicated anesthesiologists to their surgery due to high mortality and morbidity rate of anesthesiology services at that time (indirectly referring to the way anesthesiology was being delivered by the MDs, I guess).

Anyway, I don't know who's right or wrong. I just want to bring some awareness to my med student friends about this issue since many specialties will be facing it one way or another from CRNAs or DNPs.

Thanks.

 

[SxRx]

No one?

 

[countingdays]

First off THAT WAS NOT A STUDY. Studies attempt to reach true, unbiased conclusions by excluding confounding factors and by impartial analysis of data. The purpose of that publication was as a propaganda piece by a political organization.

They compare complication rates in opt out states where 22% of cases are billed as independent crna cases compared to 12% of cases in non- opt out states. There are many problems with their approach.

There is no consideration of what types of cases crnas are doing alone. What portion of the cases were cataracts, colonoscopies, cosmetics, or minor surgeries in healthy young people, etc?

There is the false assumption that medical records are accurate at documenting all complications.

There is the false assumption that billing a case as an independent crna means that MDs are not available to save their a$ses. You lose billing if supervision ratios are exceded, even for a minute in cases that last hours. Some groups avoid this potential problem by having crnas bill as independent providers. There are still doctors there who can and do contribute to the patients' care. These are 'independent crna cases' according to the billing records, but with MD supervision/availability in actual practice.

There were not enough patients to draw meaningful conclusions about rare complications. The fact that they attempt to draw conclusions shows their bias, not the results of the data. If you were designing a study, you would find out how many cases needed to be examined for the study the be adequately powered, and you would examine at least that many records. What they did was pick an inadequate, arbitrary number of patients and pretend that their results were significant.

The implied conclusion is that unsupervised nurses are as safe as supervised nurses without qualification. At the very least, they should qualify their unsupported conclusion. At best they should admit that the study was inadequate to make any statement whatsoever about safety in anesthesia.

It could very well be true that the difference in complication rates between some supervised and some unsupervised crnas is not significant. It would probably only be true for selected low-risk cases. It would probably only be true for select crnas, which ones you have no way to know. The fact is that their latest propaganda piece adds nothing to our knowledge but goes a long way toward misinforming the public and politicians.