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    More Hospitals Are Looking to CRNAs

    By Nancy Deutsch, RN, contributor.       

    Whenever there are two professionals vying for the same job, there is bound to be competition and controversy over who performs the job better. In the case of Certified Registered Nurse Anesthetists (CRNAs) and anesthesiologists who both give anesthesia to obstetrical patients, a recent study suggests that both perform the task safely.

    Anesthesiologists are becoming less interested in that area of practice because many obstetrical patients are on public assistance and there is not high reimbursement, said Daniel Simonson, CRNA, MHPA, chief anesthetist and managing partner of The Spokane Eye Surgery Center in Spokane, Washington, and principal author of the article that appeared in Nursing Research. This is one of the reasons he focused his research on obstetrical patients.

    Simonson said he was motivated to conduct the study after research in 1993 by Jeffrey Silber, M.D., suggested that when anesthesiologists were not involved in the giving of anesthesia, there were a greater number of deaths. That study involved senior citizens, whose cause of death are often hard to pinpoint, Simonson said.

    He has also occasionally heard concern that CRNAs do not provide high quality care. “That wasn’t my experience,” Simonson said, so he set out to prove otherwise.

    Simonson used administrative, retrospective data on 134, 806 obstetrical patients. Of these, 33,236 patients were treated in hospitals where only CRNAs were employed, and 101, 570 were in hospitals where only anesthesiologists worked. All were from the state of Washington, and discharge data was used for the years from 1993 to 2004. The rates of complications were similar (.58 percent versus .76 percent) when a regression analysis was done that factored out things like patient comorbidities, Simonson explained.

    “Women die very seldom from anesthesia” so there were virtually no deaths and the death rate could not be compared, he said.

    Simonson was quick to point out that the study did not directly look at CRNAs versus anesthesiologists. “This is about hospitals that employ CRNAs versus hospitals that employ anesthesiologists.

    “The result is, we become equal.”

    Simonson said he just hoped to find what he thought was true- that CRNAs provide a safe environment for patients. “The CRNAs don’t have to prove that we’re better. We just have to prove we’re the same.”

    The study results were received as expected. CRNAs love the research, Simonson said, but “anesthesiologists don’t like the results.”

    Past- president of the American Society of Anesthesiologists Mark Lema, M.D., wrote a letter after the article appeared, in which he found flaws with the research. He argued that problems included using administrative data, the study was retrospective in nature, and Simonson relied on surveying hospitals which may have provided some incorrect information.

    Simonson said those are valid points. “I think it’s probably still pretty good (data). Studies like this don’t prove anything. They suggest things.”

    The study found some other interesting data not particularly relevant to this particular point of study, such as that CRNAs tend to take care of more Medicaid patients and younger patients than do anesthesiologists, Simonson said.

    As for the competition between the two groups, “it’s an ongoing battle,” Simonson said, and one that’s not likely to be resolved anytime soon. Anytime you have two professions interacting there is healthy competition, he noted.



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