Researchers studying anesthesia safety found no differences in care between nurse anesthetists and physician anesthesiologists based on an exhaustive analysis of research literature published in the United States and around the world, according to a scientific literature review titled “Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients” prepared by The Cochrane Collaboration.
Headquartered in England, the esteemed Cochrane Collaboration is an independent, international network of healthcare practitioners, researchers, patient advocates and others who analyze healthcare research to produce credible, accessible health information. This high-quality, relevant and up-to-date information supports healthcare professionals, legislators/regulators, and patients in making better-informed healthcare choices.
The objective of the anesthesia study (Issue 7 of The Cochrane Library, 2014) was to assess the safety and effectiveness of different anesthesia providers for patients undergoing surgical procedures under general, regional or epidural anesthesia. The inquiry was motivated by “an increasing demand for surgery, pressure on healthcare providers to reduce costs, and a predicted shortfall in the number of medically qualified anaesthetists (anesthesiologists),” the report stated.
“We hoped that this may lead to an increase in confidence in the skills of NPAs (nonphysician anesthetists) within the anaesthetic community and may potentially lead to greater flexibility in team roles, both within and between countries, depending on patient need,” the researchers noted in their paper as part of their rationale for “Why it is important to do this review.”
In the United States, Certified Registered Nurse Anesthetists (CRNAs) are the hands-on providers of more than 34 million anesthetics to patients each year. As advanced practice registered nurses, CRNAs attain 7-8 years of education, training, and critical care nursing experience resulting in a master’s or doctoral degree. They deliver anesthesia to patients in the same types of facilities, for the same types of procedures, and using the same techniques and standards of care as physician anesthesiologists.
“The Cochrane Collaboration is revered as one of the most thorough, unbiased research entities in the world,” said Dennis Bless, CRNA, MS, president of the 47,000-member American Association of Nurse Anesthetists (AANA). “Based on the collaboration’s findings, we believe the U.S. healthcare industry and state and federal policymakers can continue to have confidence that greater utilization of CRNAs to the fullest extent of their scope of practice and skills promotes patient access to safe, cost-effective anesthesia care, especially now when it is desperately needed.”
The question explored by the collaboration has been the subject of numerous research studies over the years. More than 8,000 unique research papers were identified for the literature review, with a total of six meeting all of the requirements for inclusion in the final, extensive analysis.
The researchers concluded that, “No definitive statement can be made about the possible superiority of one type of anesthesia care over another.” It was noted that the complexity of perioperative care, the low intrinsic rate of complications related directly to anesthesia, and the limitations of the data used in the non-randomized studies reviewed make it impossible to provide a definitive answer to the review question.
In 2010, an extensive literature review also lead researchers from the Lewin Group to conclude that there are no differences in the safety of CRNAs compared with anesthesiologists. Their findings were published in Nursing Economic$ as part of a study titled “Cost Effectiveness Analysis of Anesthesia Providers.”
The Cochrane Collaboration relies on more than 31,000 volunteers in 120 countries to conduct systematic reviews of randomized, controlled trials of healthcare interventions, and occasionally non-randomized studies as well. The collaboration has had an official relationship with the World Health Organization (WHO) since 2011.
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