As anesthesiologists increasingly work in care teams to help improve patient care and reduce costs, using advanced practitioners (what are sometimes called mid-level or nonphysician providers) has become an attractive option. While many practices may already employ Certified Registered Nurse Anesthetists (CRNAs), an option that has been around for more than 80 years, more recently a new option has become available: Certified Anesthesiologist Assistants (CAAs).
According to the American Academy of Anesthesiologists Assistants, the AA concept was first introduced in the 1960s when anesthesiologists began dreaming of “anesthesia technologists” to assist them. By 1969, the first training program was established, and in 1989, the National Commission for the Certification of Anesthesiologist Assistants (NCCAA) was established.
Today, CAAs are highly skilled health professionals who must complete a comprehensive didactic and clinical program at the graduate school level. They can provide a wide range of anesthesia-related medical procedures and services, including the following:
- drawing arterial and venous blood samples;
- performing the insertion of invasive monitoring modalities such as TEE probes, arterial lines, pulmonary artery catheterization, and central venous lines as delegated by the Physician Anesthesiologist;
- administering anesthetic agents and any controlled substances including, but not limited to, administration of induction agents, maintaining and altering anesthesia levels, administering adjunctive treatment and providing continuity of anesthetic care into and during the post-operative recovery period;
- establishing airway interventions and performing ventilatory support;
- evaluating and treating life-threatening situations, such as cardiopulmonary resuscitation, on the basis of established protocols (BLS, ACLS, and PALS);
- and many more.
Also CAAs and CRNAs perform similar duties, the two professions do have some differences. Unlike CRNAs, who are trained through a nursing paradigm, CAAs follow a premedical training trajectory. Also, while CRNAs can be supervised by physicians in any specialty (or none at all, in some states), CAAs must be supervised by an anesthesiologist.
Not all states have passed legislation authorizing the licensing and hiring of CAAs. According to the AAAA, 14 states, including Indiana, and 2 jurisdictions (Washington D.C. and Guam) currently allow CAAs to practice. Also, the Centers for Medicare and Medicaid Services (CMS) and most commercial payers also recognize CAAs as non-physician anesthesia providers, and CAAs can practice at VA facilities in all 50 states.
To learn more about CAAs and how to include them in your care team, visit the AAAA’s website. For a side-by-side comparison of the training and practices of CRNAs and CAAs, review the AAAA’s helpful table that is part of the ASA’s “Statement Comparing Anesthesiologist Assistant and Nurse Anesthetist Education and Practice.”
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