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One more study

Discussion in 'Anesthesiology' started by Planktonmd, Apr 21, 2007.

  1. Planktonmd

    Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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  3. urgewrx

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    I'm sure there is no bias in that study.
     
  4. Hawaiian Bruin

    Hawaiian Bruin Breaking Good
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    So, what kind we do about this kind of research, which pays no attention to hospital acuity, demographics etc?

    Here's the abstract. Note how bad they wanted to say that CRNAs had a lower complication rate than MDs.

    Anesthesia Staffing and Anesthetic Complications During Cesarean Delivery: A Retrospective Analysis.

    FEATURES
    Nursing Research. 56(1):9-17, January/February 2007.
    Simonson, Daniel C.; Ahern, Melissa M.; Hendryx, Michael S.

    Abstract:
    Background: Obstetrical anesthesia services may be provided by Certified Registered Nurse Anesthetists (CRNAs), anesthesiologists, or a combination of the two providers. Research is needed to assist hospitals and anesthesia groups in making cost-effective staffing choices.

    Objectives: To identify differences in the rates of anesthetic complications in hospitals whose obstetrical anesthesia is provided solely by CRNAs compared to hospitals with only anesthesiologists.

    Methods: Washington State hospital discharge data were obtained from 1993 to 2004 for all cesarean sections, and were merged with a survey of hospital obstetrical anesthesia staffing. Anesthetic complications were identified via International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. Resulting rates were risk-adjusted using regression analysis.

    Results: Hospitals with CRNA-only staffing had a lower rate of anesthetic complications than those with anesthesiologist staffing (0.58% vs. 0.76%, p =.0006). However, after regression analysis, this difference was not significant (odds ratio for CRNA vs. anesthesiologist complications: 1.046 to 1, 95% confidence interval 0.649-1.658, p =.85).

    Discussion: There is no difference in rates of complications between the two types of staffing models. As a result, hospitals and anesthesiology groups may safely examine other variables, such as provider availability and costs, when staffing for obstetrical anesthesia. Further study is needed to validate the use of ICD-9-CM codes for anesthesia complications as an indicator of quality.
     
  5. urgewrx

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    That's pathetic. Writting a whole thesis based on something that has not been proven useful. I think the best data for outcome studies will come from insurace company closed claims. I expect we'll be hearing about this in the next couple of years.
     
  6. swpm

    swpm Now with extra snarkiness
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    There's nothing we can do about nurses publishing poorly designed fatally, flawed studies in nursing journals.

    Every one of us knows, and every nurse knows, that if a patient is given the honest, undisguised, unmitigated by propaganda choice between a doctor and a nurse, that they'll choose a doctor.

    CRNAs have made progress through misdirection and obfuscation. This is more of the same. All we need to do is loudly and publicly cut through that fog.

    Radiologists post gigantic posters that say Do you know who's reading your films? Demand a board certified radiologist. We could be plastering that message on every billboard surrounding every hospital in the nation.

    CRNAs prey on their patients' ignorance. The ASA ought to turn the tables and prey on our patients' insecurity and narcissism. (You're special. You're a snowflake. You deserve the very best. You deserve a doctor, not a nurse.)
     
  7. swpm

    swpm Now with extra snarkiness
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    I don't know if we'll see it until well after CRNAs get their "right" to practice independently. Until then, how can independent CRNAs and anesthesiologists ever be directly compared? To do the study you'd have to subject sick patients to the care of an unsupervised CRNA, who doesn't have an MD/DO anesthesiologist down the hall to unscrew things when they go sour. That's an unethical study to perform.

    This is the fatal flaw with all of these stupid outcome studies. When bad things happen to a CRNA's patient, there's usually an anesthesiologist around to bail them out. If a CRNA loses an airway, or does something careless, and the anesthesiologist rushes in and saves the patient's life, that still goes in the study as one more "non-death" for a CRNA ... "proving" their competence.

    I fear for the day when we have truly independent CRNAs practicing, in situations where there's no doctor to rescue them ... because that's when the bodies will start to pile up. I'm a resident, and a junior one at that, and at least 2-3 times a month my mind just boggles at the things CRNAs do, or say they're going to do before the supervising anesthesiologist picks his jaw up off the floor and corrects them.
     
  8. urgewrx

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    What are you talking about? There is a bunch of CRNA's practicing solo as we speak. No anesthesiologist in a 100 miles, or so, to bail them out.
     
  9. Hawaiian Bruin

    Hawaiian Bruin Breaking Good
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    Fantastic. That gets my vote as Billboard Ad #1. Maybe have a photo of a guy in scrubs and mask with his MD nametag clearly visible, giving the thumbs-up with a wink.
     
  10. Hawaiian Bruin

    Hawaiian Bruin Breaking Good
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  11. excalibur

    excalibur Member
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    it's good to see that the jedis are still holding strong
     
  12. Heeed!

    Heeed! On target, On time!
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    Turn that into your avatar!:thumbup:
     
  13. VolatileAgent

    VolatileAgent Livin' the dream
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    there may be no statistical difference between providers in low-risk obstetrics in community-based hospitals.

    i want to see if there is similar parity in high-risk obstetrics.
     
  14. Bertelman

    Bertelman Maverick!
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    Brilliant, especially the X'ed out eyes. Somehow, though, I don't think portraying us seated in a chair, although honest, is the best way to command respect.
     
  15. Hawaiian Bruin

    Hawaiian Bruin Breaking Good
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    Thanks! Maybe I'll redo it with the guy standing and wearing a superhero cape like I originally intended...
     
  16. excalibur

    excalibur Member
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    Bruin, what's the new avatar? I can't make it out.
     
  17. Hawaiian Bruin

    Hawaiian Bruin Breaking Good
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    It was my old avatar that got lost in the ether somehow- it's looking out at a sunset inside the barrel of a wave. I'll probably change it soon if I get around to it.
     

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