Having either an anesthesiologist assistant or a nurse anesthetist serving on an anesthesia care team appears to produce the same results, according to a new study by Stanford University researchers. Based on their findings, care team composition does not seem to be linked to differences in patient mortality, hospital length of stay, or inpatient care costs.
Dr. Eric C. Sun, MD, PhD, an assistant professor of anesthesiology, perioperative and pain medicine at Stanford University in California, and his team compared 421,230 surgical cases that included a nurse anesthetist and 21,868 cases with an anesthesiologist assistant between Jan. 1, 2004 and Dec. 31, 2011. All cases involved a geriatric patient between the ages of 65 and 89 years, and a physician anesthesiologist functioned as the supervisor in all cases.
According to Deanna DePeau of Anesthesiology News, the lack of differences in mortality, length of stay, and medical spending led researchers to conclude that “surgical care provided by an anesthesiologist assistant or nurse anesthetist is equivalent when each is supervised by a physician anesthesiologist.”
While the Centers for Medicare and Medicaid Services (CMS) and most commercial payers already recognize certified anesthesiologist assistant (CAAs) as non-physician anesthesia providers, and CAAs can practice at VA facilities in all 50 states, this study could be significant for the advancement of anesthesiologist assistant licensure in additional states. Currently only 14 states, including Indiana, and 2 jurisdictions (Washington D.C. and Guam) allow CAAs to practice.
Compare that to Certified Registered Nurse Anesthetists (CRNAs), which are allowed to practice under the supervision of physicians in all 50 states, and can even practice without supervision in 17 states that have opted out of the federal physician supervision requirement. Those states include Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, Colorado, and Kentucky.
Recently, the American Society of Anesthesiologists (ASA), which is opposed to CRNAs practicing without physician supervision, advocated on behalf of CAAs in a letter to Veterans Administration Executive in Charge, Carolyn Clancy, M.D. In their comments about a proposed Anesthesia Directive, which would replace the long-serving Anesthesia Service Handbook and align VA Anesthesia Care Team policy with the final APRN rule, the ASA recommended that CAAs be recognized in the definition of the Anesthesia Team and throughout the Anesthesia Directive as CAAs and that a separate appendix for Certified Anesthesiologist Assistant Practice Guidelines be included in the final Directive. The ASA also recommended that Anesthesiologist Assistants be eligible for membership on the National Anesthesia Service Field Advisory Committee.
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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