Thursday, August 28, 2014

The ASA Is Getting Desperate about CRNA's

I received this email from the ASA the other day. It breathlessly declared, "Nurse anesthetist care not equal to physician anesthesiologist-led care, comprehensive evidence-based review finds." I thought, Whoa! Did the ASA just discover the Holy Grail that will finally demonstrate the superiority of anesthesiologists over CRNA's?

So I dig a little deeper. The ASA is citing a study conducted by the Cochrane Collaboration, a "global independent network of health practitioners, researchers, patient advocates, and others..." The study is called, "Physician anaesthetists versus nurse anaesthetists for surgical patients." It is actually a meta-analysis of six different papers that tried to compare the quality of work of anesthesiologists versus CRNA's. The six articles combined had over 1.5 million patient records. None of these studies were blinded due to ethical and impractical reasons.

After reviewing all the studies, the authors felt that none of the papers could conclusively declare that anesthesiologists or CRNA's gave better care. Some appeared to give the advantage to the nurses while others favored the doctors. But all of them were too flawed to declare the results unequivocal. The studies did not properly account for the different acuity levels of patients that were treated by physicians versus nurses. The different practice locations of the two professionals, Level 1 trauma center vs. rural community hospital, were not adequately taken into consideration. There were large variations in how the papers treated the complication rates.

Ultimately the authors stated that there were just too many variables involved to make a strong statement. They concluded, "it was not possible to say whether there were any differences in care between medically qualified anaesthetists and nurse anaesthetists from the available evidence."

The inability to document the superiority of anesthesiologists versus CRNA's in the final result doesn't exactly conform to the screaming headline the ASA is trying to plaster all over the internet. Is the ASA becoming so desperate in its attempt to disparage the nurses that they will twist a scientific paper to justify its own personal beliefs even if the paper doesn't support that goal in any way?

As anesthesia technology and techniques continue to improve, that objective is going to get even harder. Through rigorous research conducted by physicians, we are constantly striving to improve the safety profile of our field. Then we magnanimously pass along this new knowledge to anesthesia and SRNA residents without prejudice because we believe patient safety is the number one goal of all anesthesia providers regardless of degree. So it's no wonder there will be very little documentable evidence of physician superiority, even though we can feel it through every fiber of our being. The ASA is going to have to try a lot harder than mischaracterizing a research paper to prove to its members that they are in fact number one.

1 comment:

  1. As a current RN that is unhappy with her job. I am trying to decide if I'd like to go to CRNA school, which would only be an additional 2 year program or if I'd like to become a anesthesiologist which would mean I have to start from the beginning of the medical school process. Would all the schooling be work it to become an anesthesiologist? I'm not sure of the advantages of being the doctor vs the nurse in the realm of anesthesia.

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