how do you guys feels about general and OB care including induction emergenc e, epidural and spinal with CRNAs.
What is the line to take over and how much to delegate. Its a fast and changing field and our credit is on line with court
Ours is a by-the-book ACT practice. No more than 1:4 medical direction, and meeting all the TEFRA requirements that "medical direction" requires (present at induction and emergence and the other 5 requirements). We have an anesthesiologist and anesthetists in-house 24/7, so there is NEVER a time that an anesthesiologist is not involved with the care of our patients. We have an extremely busy community hospital practice (PM me if you want some numbers and how we manage), but are staffed appropriately with anesthesiologists, AA's, and CRNA's (and even some NP's) to handle the caseload.
In my particular practice, none of our anesthetists do regionals or central lines. The best person to make the decision of who does what is the anesthesiologist at the local level. In fact it's entirely
practice or hospital specific, and there are no state laws that say CRNA's or AA's can't do these procedures.
I learned how to place central lines and Swans from a well-known cardiac anesthesiologist, back before we even had pre-made kits available to us. In my first practice, I did countless central lines, Swans, and SAB's. That's just the way we practiced. All were within my scope of practice (and from the state's standpoint, still are). My current practice does not allow this (although my moonlighting practice does), but hey, I knew that going in, and my competency is not measured by where I can stick a needle. With that, and because my practice is epidural-centric and rarely needs central lines, I'm in the curious position of having done more spinals, CVL's, and Swans than most of my attendings.
