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Journal articles on the topic 'Certified Registered Nurse Anesthetist'

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Published: 4 June 2021
Last updated: 16 February 2022

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1

Wilson, Heather, and Margaret Compton. "Reentry of the Addicted Certified Registered Nurse Anesthetist." Journal of Addictions Nursing 20, no. 4 (2009): 177–84. http://dx.doi.org/10.3109/10884600903078951.

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2

Boyd, Donald, and Lusine Poghosyan. "Measuring Certified Registered Nurse Anesthetist Organizational Climate: Instrument Adaptation." Journal of Nursing Measurement 25, no. 2 (2017): 224–37. http://dx.doi.org/10.1891/1061-3749.25.2.224.

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Background and Purpose: No tool exists measuring certified registered nurse anesthetist (CRNA) organizational climate. The study’s purpose is to adapt a validated tool to measure CRNA organizational climate. Methods: Content validity of the Certified Registered Nurse Anesthetist Organizational Climate Questionnaire (CRNA-OCQ) was established. Pilot testing was conducted to determine internal reliability consistency of the subscales. Results: Experts rated the tool as content valid. The subscales had high internal consistency reliability (with respective Cronbach’s alphas): CRNA-Anesthesiologist Relations (.753), CRNA-Physician Relations (.833), CRNA-Administration Relations (.895), Independent Practice (.830), Support for CRNA Practice (.683), and Professional Visibility (.772). Conclusions: Further refinement of the CRNA-OCQ is necessary. Measurement and assessment of CRNA organizational climate may produce evidence needed to improve provider and patient outcomes.
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3

McMullan, Susan P., Charlotte Thomas-Hawkins, and Maria R. Shirey. "Certified Registered Nurse Anesthetist Perceptions of Factors Impacting Patient Safety." Nursing Administration Quarterly 41, no. 1 (2017): 56–69. http://dx.doi.org/10.1097/naq.0000000000000204.

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4

Izlar, Janice J. "Health Care Challenges to the Certified Registered Nurse Anesthetist as an Advanced Practice Registered Nurse." Clinical Scholars Review 7, no. 1 (2014): 7–9. http://dx.doi.org/10.1891/1939-2095.7.1.7.

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5

Moos, Daniel D. "Certified Registered Nurse Anesthetists in America." British Journal of Anaesthetic and Recovery Nursing 8, no. 4 (2007): 79–82. http://dx.doi.org/10.1017/s1742645607000290.

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ABSTRACTNurse anesthetists are crucial healthcare providers throughout the world. The duties, regulations, and educational requirements for nurse anesthetists vary from country to country. The purpose of this article is to provide the reader with a brief historical perspective on the development of nurse anesthesia in the United States; describe current nurse anesthesia practice; and allow the reader to compare and contrast it with the practice of nurse anesthesia in their own country.
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6

Posa-Kearney, Kathleen, Samantha M. Aranda, Elizabeth M. Day, et al. "Impact of Clinical Nurse Specialist Roles on COVID-19 Pandemic Care." Connect: The World of Critical Care Nursing 14, no. 3 (2020): 141–46. http://dx.doi.org/10.1891/wfccn-d-20-00028.

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Advanced practice nurses including nurse practitioners, clinical nurse specialists (CNS), certified registered nurse anesthetists, and certified nurse midwives contribute in many ways to improve care in the intensive care unit. This article reports on the roles of the CNS at an academic medical center and how they contribute to improving patient outcomes and support critical care nursing practice during the COVID-19 pandemic.
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7

Scott-Herring, Mary, and Sarabdeep Singh. "Development, Implementation, and Evaluation of a Certified Registered Nurse Anesthetist Preceptorship–Mentorship Program." Journal of Continuing Education in Nursing 48, no. 10 (2017): 464–73. http://dx.doi.org/10.3928/00220124-20170918-08.

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8

Hamza, Heather, and Todd Monroe. "Reentry and Recidivism for Certified Registered Nurse Anesthetists." Journal of Nursing Regulation 2, no. 1 (2011): 17–22. http://dx.doi.org/10.1016/s2155-8256(15)30297-0.

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9

Hensel, Desiree, Rachel Cooper, and Neil Craney. "Operating Room Personnel Viewpoints About Certified Registered Nurse Anesthetists." Western Journal of Nursing Research 40, no. 2 (2016): 242–56. http://dx.doi.org/10.1177/0193945916682730.

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10

Carter, T’Anya, Susan P. McMullan, and Patricia A. Patrician. "Barriers to Reentry Into Nurse Anesthesia Practice Following Substance Use Disorder Treatment: A Concept Analysis." Workplace Health & Safety 67, no. 4 (2019): 189–99. http://dx.doi.org/10.1177/2165079918813378.

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Nursing knowledge surrounding anesthesia providers’ maintaining or obtaining employment after treatment of substance use disorder (SUD) is notably absent in the literature. An alternative method, dimensional analysis, allows for exploration of this concept from many perspectives, with social context as the basis from which to determine what barriers exist and how to prevail over them. Anesthesia practice is a socially constructed profession. The concept, barriers to reentry into nurse anesthesia practice, was explored and defined for purposes of identifying their impact on the recovering certified registered nurse anesthetist (CRNA). Defining the barriers places the CRNA one step closer to successful reentry into anesthesia practice.
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Houghton, Chad S., Anthony W. Marcukaitis, Mary E. Shirk Marienau, Michael Hooten, Susanna R. Stevens, and David O. Warner. "Tobacco Intervention Attitudes and Practices Among Certified Registered Nurse Anesthetists." Nursing Research 57, no. 2 (2008): 123–29. http://dx.doi.org/10.1097/01.nnr.0000313481.39755.ea.

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12

Beissel, Donald E. "Validity of Certified Registered Nurse Anesthetist Complication Rates When Performing Fluoroscopic Guided Interlaminar Lumbar Epidural Steroid Injections." Journal for Healthcare Quality 38, no. 6 (2016): e99-e100. http://dx.doi.org/10.1097/jhq.0000000000000012.

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13

Howie, William, Mary Scott-Herring, Andrew N. Pollak, and Samuel M. Galvagno. "Advanced Prehospital Trauma Resuscitation With a Physician and Certified Registered Nurse Anesthetist: The Shock Trauma “Go-Team”." Air Medical Journal 39, no. 1 (2020): 51–55. http://dx.doi.org/10.1016/j.amj.2019.09.004.

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14

Sipe, Theresa Ann, Judith T. Fullerton, and Kerri Durnell Schuiling. "Demographic Profiles of Certified Nurse–Midwives, Certified Registered Nurse Anesthetists, and Nurse Practitioners: Reflections on Implications for Uniform Education and Regulation." Journal of Professional Nursing 25, no. 3 (2009): 178–85. http://dx.doi.org/10.1016/j.profnurs.2009.01.002.

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15

Matsusaki, Takashi, and Tetsuro Sakai. "The role of Certified Registered Nurse Anesthetists in the United States." Journal of Anesthesia 25, no. 5 (2011): 734–40. http://dx.doi.org/10.1007/s00540-011-1193-5.

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16

Edwards, John M., Stace D. Dollar, Thomas Young, and Dorothy Brockopp. "The Role of a Certified Registered Nurse Anesthetist Led Acute Pain Service in Preventing Persistent Postoperative Opioid Use." JONA: The Journal of Nursing Administration 50, no. 4 (2020): 198–202. http://dx.doi.org/10.1097/nna.0000000000000868.

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17

Jacobson, Nadine M. "Policy Update: Final Rule on Physician Supervision for Certified Registered Nurse Anesthetists." Policy, Politics, & Nursing Practice 2, no. 2 (2001): 157–60. http://dx.doi.org/10.1177/152715440100200212.

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18

DeFord, Stephanie, Julie Bonom, and Terri Durbin. "A review of literature on substance abuse among anaesthesia providers." Journal of Research in Nursing 24, no. 8 (2019): 587–600. http://dx.doi.org/10.1177/1744987119827353.

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Background Research has demonstrated that anaesthesia providers are susceptible to substance abuse. Several preventive measures are being implemented in certified registered nurse anaesthetist programmes to educate future providers about substance abuse. Given the continued prevalence and impact of the problem, more research is needed about the prevalence of substance abuse among student registered nurse anaesthetists and the implementation of preventive strategies in the educational setting. Aims The purpose of this narrative literature review was to examine the state of the science related to substance abuse among US certified anaesthesia providers. This literature review covered abuse of alcohol, tobacco, recreational drugs, opioids and anaesthetic agents. Methods This narrative review was conducted using the following search terms: anaesthesia, student, wellness, stress, substance abuse, satisfaction, personality, depression, nurse, nurse anaesthetist, propofol, isoflurane and fentanyl. References were identified using PubMed, CINAHL, Google Scholar, and the American Society of Anesthesiologists and American Association of Nurse Anesthetists websites. A total of 36 articles were identified as relevant to this literature review based on content and country of publication. This literature review was limited to articles published in the past 15 years. With one exception, our search was limited to manuscripts from the US. Results The literature underscored that various risk factors contribute to substance abuse. Board-certified anaesthesia providers fall prey to substance abuse due to ease of access, the high stress associated with administering anaesthesia, and the propensity to become addicted to opioids and other anaesthetics. A gap in the science exists about the prevalence of substance abuse among student registered nurse anaesthetists and the effectiveness of preventive strategies in the educational setting. Conclusions Anaesthesia providers are at high risk of abusing substances. To create a safer environment, future research should explore the prevalence of substance abuse among student registered nurse anaesthetists and emphasise the integration of effective preventive strategies in the educational setting.
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19

Riddle, Dru, Mat Gregoski, Kathy Baker, Bonnie Dumas, and Carolyn H. Jenkins. "Impressions of pharmacogenomic testing among Certified Registered Nurse Anesthetists: a mixed-method study." Pharmacogenomics 17, no. 6 (2016): 593–602. http://dx.doi.org/10.2217/pgs.16.3.

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20

Schlepp, Susan. "RN first assistant legislation reintroduced; certified registered nurse anesthetists to receive Medicare reimbursement." AORN Journal 49, no. 4 (1989): 966–72. http://dx.doi.org/10.1016/s0001-2092(07)66804-5.

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21

Wax, David B., Yaakov Beilin, Sabera Hossain, Hung-Mo Lin, and David L. Reich. "Manual Editing of Automatically Recorded Data in an Anesthesia Information Management System." Anesthesiology 109, no. 5 (2008): 811–15. http://dx.doi.org/10.1097/aln.0b013e3181895f70.

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Background Anesthesia information management systems allow automatic recording of physiologic and anesthetic data. The authors investigated the prevalence of such data modification in an academic medical center. Methods The authors queried their anesthesia information management system database of anesthetics performed in 2006 and tabulated the counts of data points for automatically recorded physiologic and anesthetic parameters as well as the subset of those data that were manually invalidated by clinicians (both with and without alternate values manually appended). Patient, practitioner, data source, and timing characteristics of recorded values were also extracted to determine their associations with editing of various parameters in the anesthesia information management system record. Results A total of 29,491 cases were analyzed, 19% of which had one or more data points manually invalidated. Among 58 attending anesthesiologists, each invalidated data in a median of 7% of their cases when working as a sole practitioner. A minority of invalidated values were manually appended with alternate values. Pulse rate, blood pressure, and pulse oximetry were the most commonly invalidated parameters. Data invalidation usually resulted in a decrease in parameter variance. Factors independently associated with invalidation included extreme physiologic values, American Society of Anesthesiologists physical status classification, emergency status, timing (phase of the procedure/anesthetic), presence of an intraarterial catheter, resident or certified registered nurse anesthetist involvement, and procedure duration. Conclusions Editing of physiologic data automatically recorded in an anesthesia information management system is a common practice and results in decreased variability of intraoperative data. Further investigation may clarify the reasons for and consequences of this behavior.
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22

Henrichs, Bernadette M., Michael S. Avidan, Dave J. Murray, et al. "Performance of Certified Registered Nurse Anesthetists and Anesthesiologists in a Simulation-Based Skills Assessment." Anesthesia & Analgesia 108, no. 1 (2009): 255–62. http://dx.doi.org/10.1213/ane.0b013e31818e3d58.

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23

Jenkins, Constance L., Aaron R. Elliott, and Janet R. Harris. "Identifying Ethical Issues of the Department of the Army Civilian and Army Nurse Corps Certified Registered Nurse Anesthetists." Military Medicine 171, no. 8 (2006): 762–69. http://dx.doi.org/10.7205/milmed.171.8.762.

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24

Massie, Maribeth Leigh. "The Tipping Point in Health Care: Using the Full Scope of Practice of Certified Registered Nurse Anesthetists as Advanced Practice Registered Nurses." Clinical Scholars Review 7, no. 1 (2014): 4–6. http://dx.doi.org/10.1891/1939-2095.7.1.4.

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25

Feyereisen, Scott, and Elizabeth Goodrick. "Who is in charge? Jurisdictional contests and organizational outcomes." Journal of Professions and Organization 6, no. 2 (2019): 233–45. http://dx.doi.org/10.1093/jpo/joz008.

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Abstract We explored how professional jurisdiction contests influence organizational outcomes by examining how Certified Registered Nurse Anesthetist (CRNA) schools in the USA were impacted by a policy pursuing educational upskilling. While others have focused on boundary work at the field and work levels, we argue that contests between professions also influence important organizational outcomes. We detail how the profession’s accreditation decision requiring schools to provide Master’s degrees within a 17 year window took place in the context of physicians historically battling CRNAs. We provide an analytic narrative illustrating the history of this jurisdictional dispute, and empirically examine how CRNA schools with cultures differentially supportive of physicians’ field-level dominance responded to the requirement of educational upskilling. Our analysis indicates that the timing of a school adopting a graduate program was influenced by whether the organizational culture, represented by organizational ownership, supported physician dominance. We also highlight the importance of access to resources as another conduit for boundary work impacting organizational outcomes.
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26

Dexter, Franklin, Danielle Masursky, and Bradley J. Hindman. "Reliability and Validity of the Anesthesiologist Supervision Instrument When Certified Registered Nurse Anesthetists Provide Scores." Anesthesia & Analgesia 120, no. 1 (2015): 214–19. http://dx.doi.org/10.1213/ane.0000000000000510.

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27

Sasse, Roxana. "The Role of Certified Registered Nurse Anesthetists and the Need for New Models of Care." Clinical Scholars Review 7, no. 1 (2014): 3. http://dx.doi.org/10.1891/1939-2095.7.1.3.

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28

Pollard, Richard J., Joseph P. Coyle, Richard L. Gilbert, and Janet E. Beck. "Intraoperative Awareness in a Regional Medical System." Anesthesiology 106, no. 2 (2007): 269–74. http://dx.doi.org/10.1097/00000542-200702000-00014.

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Background Intraoperative awareness in patients undergoing general anesthesia is an infrequent but well-described adverse outcome. The reported incidence of this phenomenon is between 0.1% and 0.9%. Methods With institutional review board approval, the authors reviewed continuous quality improvement data from 3 yr (2002-2004) at the locations where the physician group provided anesthesia. Board-certified anesthesiologists supervising certified registered nurse anesthetists in the anesthesia care team model of practice delivered all anesthetics. Brain function monitors were not used in the operating room setting. Patients were interviewed twice during a 48-h postoperative period and, as part of that process, underwent a modified Brice interview to determine intraoperative awareness. All cases that met the criteria for awareness were examined by the continuous quality improvement committee to modify anesthetic practice and were included in this study. Results Data from 211,842 patients undergoing anesthesia were considered. Of these, the continuous quality improvement process followed up 177,468 (83.1%). Cases were not included in the study if the patient was younger than 18 yr, did not have a general anesthetic, or had a terminal event during the hospital course. By these criteria, a total of 87,361 patients followed by the continuous quality improvement process were at risk for awareness. Six patients reported instances of recall. Conclusion The incidence of intraoperative awareness in this large sample of patients from a regional medical center undergoing general anesthesia was 0.0068%, or 1 per 14,560 patients, substantially less than that reported in the recent literature.
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29

Dexter, Franklin, Johannes Ledolter, Cynthia A. Wong, and Bradley J. Hindman. "Association between leniency of anesthesiologists when evaluating certified registered nurse anesthetists and when evaluating didactic lectures." Health Care Management Science 23, no. 4 (2020): 640–48. http://dx.doi.org/10.1007/s10729-020-09518-0.

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30

Lester, Rodney C. "The Use of Delphi to Identify Current and Future Role Perceptions for Certified Registered Nurse Anesthetists." Military Medicine 159, no. 4 (1994): 294–98. http://dx.doi.org/10.1093/milmed/159.4.294.

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Feyereisen, Scott, Joseph P. Broschak, and Beth Goodrick. "Understanding Professional Jurisdiction Changes in the Field of Anesthesiology." Medical Care Research and Review 75, no. 5 (2017): 612–32. http://dx.doi.org/10.1177/1077558716687889.

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We further our understanding of jurisdictional disputes between established professional groups through a 10-year longitudinal analysis of the differential adoption by U.S. states of policies expanding Certified Registered Nurse Anesthetists’ (CRNAs) autonomy. In the United States, CRNAs are trained to deliver anesthetics to patients in the same way as physician anesthesiologists but have more restrictions in practice. Following a 2001 federal decision regarding Medicare reimbursement, states were permitted but not required to allow CRNAs to practice without physician supervision, potentially reducing health care costs. We show that higher levels of incumbent physician power makes it less likely that a state will change jurisdictional boundaries, while increasing relative power among challenging CRNAs and the past successes of other challenging health professionals increase the likelihood. State labor deficiency and proximity to other adopting states also positively influenced the expansion of CRNAs’ autonomy. Implications for the professions and health services literature are discussed.
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Szigeti, Elvira, Rebecca N. Largent, and Bruce J. Eberhardt. "An Exploratory Study of the Correlates of Intent to Quit among Certified Registered Nurse Anesthetists in North Dakota." Journal of Rural Health 6, no. 3 (1990): 317–27. http://dx.doi.org/10.1111/j.1748-0361.1990.tb00670.x.

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33

Duchesne, Juan, Chad Majoue, Marquinn Duke, et al. "Impact of Trauma-Certified Registered Nurse Anesthetists Team on Intra-Operative Resuscitation and Postoperative Outcomes of Trauma Patients." American Surgeon 84, no. 1 (2018): 93–98. http://dx.doi.org/10.1177/000313481808400128.

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A Trauma Certified Registered Nurse Anesthetists Team (TCT) was created and trained to provide trauma-focused anesthesia and resuscitation. The purpose of this study was to examine patient outcomes after implementation of TCT. We conducted retrospective analyses of trauma patients managed with surgical intervention from March to December 2015. During the first five months, patients managed before the development of TCT were grouped No-TCT, patients managed after were grouped TCT. To assess outcomes, we used hospital and intensive care unit length of stay, ventilator days, and a validated 10-point intraoperative Apgar score (IOAS). IOAS is calculated using the estimated blood loss, lowest heart rate, and lowest mean arterial pressure during surgery. Higher IOAS are associated with significantly decreased complications and mortality after surgery. We used t test and nonparametric tests for analyses. Fifty two patients were included (mean age 39 years, 75% male; 46.2% managed with TCT). Patients in the No-TCT group had significantly lower use of vasopressors (0.019), lower mean IOAS ( P = 0.02), and spent more days on ventilator ( P = 0.005) than patients in the TCT. These results suggest that trauma centers should take into consideration implementation of TCT to improve intraoperative and overall outcomes.
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Ardizzone, Laura L. "Navigating the Uncertainty That Lies Ahead: Certified Registered Nurse Anesthetists and the Patient Protection and Affordable Care Act." Clinical Scholars Review 7, no. 1 (2014): 10–11. http://dx.doi.org/10.1891/1939-2095.7.1.10.

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35

Wands, Brenda A. "A survey of moral distress in certified registered nurse anesthetists: A theoretical perspective for change in ethics education for advance practice nurses." International Journal of Nursing Sciences 5, no. 2 (2018): 121–25. http://dx.doi.org/10.1016/j.ijnss.2018.03.006.

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36

Faircloth, Amanda C. "Anesthesia Involvement in Palliative Care." Annual Review of Nursing Research 35, no. 1 (2017): 135–58. http://dx.doi.org/10.1891/0739-6686.35.135.

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Palliative care teams require multidisciplinary support. While this is an emerging area in anesthesia practice, there are many avenues for certified registered nurse anesthetists (CRNAs) to share their unrivaled clinical knowledge. CRNAs may become involved with or consult on palliative sedation, medical management, interventional pain management, terminal wean/extubation, and organ donation. Additionally, CRNAs need to understand the unique needs of this patient population so that they can appropriately care for palliative care patients presenting to the operating room for palliative surgery. More research is needed to further explore CRNA involvement in palliative care. However, CRNAs have a specialized knowledge of pharmacology and physiology that perfectly complements the multidisciplinary palliative care team.
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37

Beissel, Donald E. "Complication Rates for Fluoroscopic Guided Interlaminar Lumbar Epidural Steroid Injections Performed by Certified Registered Nurse Anesthetists in Diverse Practice Settings." Journal for Healthcare Quality 38, no. 6 (2016): 344–52. http://dx.doi.org/10.1111/jhq.12093.

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38

Soto, Roy G., Daniel S. Cormican, Christopher J. Gallagher, and Peggy A. Seidman. "Teaching Systems-Based Competency in Anesthesiology Residency: Development of an Education and Assessment Tool." Journal of Graduate Medical Education 2, no. 2 (2010): 250–59. http://dx.doi.org/10.4300/jgme-d-09-00078.1.

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Abstract Background The Accreditation Council for Graduate Medical Education requires programs to educate and evaluate residents in 6 competencies, including systems-based practice. We designed a survey and assessment tool to address the competency as it pertains to anesthetic drug costs in an academic center. Methods Residents, certified registered nurse anesthetists, and faculty were asked to complete an anesthetic drug-cost survey without relying on reference materials. After a combination of compulsory in-class didactic sessions and web-based education, the participants were asked to design an anesthetic, give example cases, and determine costs. The initial task was repeated 1 year later. Results Our preintervention survey revealed that most practitioners knew very little about anesthetic drug costs, regardless of level of training or degree. All residents completed the mandatory online education tool, more than 80% attended the departmental grand rounds program, and 100% met the goal of designing an anesthetic for all cases within the preset price limit. A repeat of the cost estimate produced an improvement in cost estimates with reduction in variability (P < .05, Student unpaired t test), although estimates of volatile anesthetic and reversal agent costs did not achieve significance at the .05 level for any of the 3 cases. Conclusion Introducing a formalized teaching and assessment tool has improved our residents' understanding of anesthetic drug costs, and improved our ability to teach and assess the systems-based practice competency.
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Bonds, Raymond L. "SBAR Tool Implementation to Advance Communication, Teamwork, and the Perception of Patient Safety Culture." Creative Nursing 24, no. 2 (2018): 116–23. http://dx.doi.org/10.1891/1078-4535.24.2.116.

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Current evidence reveals that surgical patients are more prone to adverse events when compared to any other population in the acute care setting. In a military training hospital, handoff communication between surgical intensive care unit (SICU) nurses, physicians, and anesthesia providers (certified registered nurse anesthetists and anesthesiologists) about patients being prepared for surgery was identified as a problem by an initial inquiry of the staff. This article discusses an evidence-based project (EBP) that utilized a standardized multidisciplinary Situation, Background, Assessment, Recommendation (SBAR) tool to improve communication, teamwork, and the perception of a patient safety culture between the SICU nurses and physicians and the anesthesia providers in preparation for surgery. The SICU and anesthesia departments received training on the SBAR tool, followed by a 7-week implementation period. Standardized handoff communication utilizing the SBAR method increased by 100%, and documentation of intraoperative antibiotics on the electronic medication administration record increased by 43%. Postimplementation results from the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture surpassed database benchmarks for handoffs and transitions, overall perception of patient safety culture, and teamwork across units. This project reinforced current evidence supporting the use of standardized handoff communication.
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40

Backeris, Mark E., Patrick J. Forte, Shawn T. Beaman, and David G. Metro. "Financial Implications of Different Interpretations of ACGME Anesthesiology Program Requirements for Rotations in the Operating Room." Journal of Graduate Medical Education 5, no. 2 (2013): 315–19. http://dx.doi.org/10.4300/jgme-d-13-00075.1.

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Abstract Background The Accreditation Council for Graduate Medical Education (ACGME) standards for resident education in anesthesiology mandate required rotations including rotations inside the operating room (OR). When residents complete rotations outside the OR, other providers must be used to maintain the OR's clinical productivity. Objective We quantified and compared the costs of replacing residents by using two different working patterns that are compliant with the ACGME anesthesiology program requirements: (1) the minimum amount of time in the OR, and (2) working the maximum amount of time permitted in the OR. Methods We calculated resident replacement costs over a 36-month residency period in both a minimum and maximum OR time model. We used a range of Certified Registered Nurse Anesthetist (CRNA) pay scales determined by a local market analysis for cost comparisons. Results Depending on CRNA pay rates, the cost differentials to replace a resident in the OR between the minimum and maximum OR time models ranged from $236,000 to $581,876, assuming a 50-hour resident work week, and $373,400 to $931,001, assuming an 80-hour resident work week. This cost was per resident over the entire 3 years of their residency. Conclusions Varying the amount of time residents work in the OR (as allowed under ACGME program requirements) has significant financial implications over a 36-month anesthesiology residency. The larger the residency, the more significant will be the impact on the department and sponsoring institution.
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41

Kalist, David E., Noelle A. Molinari, and Stephen J. Spurr. "Cooperation and conflict between very similar occupations: the case of anesthesia." Health Economics, Policy and Law 6, no. 2 (2010): 237–64. http://dx.doi.org/10.1017/s1744133110000162.

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AbstractThis article examines the features of a labor market in which there are two professional groups that both cooperate and directly compete with each other: certified registered nurse anesthetists (CRNAs) and anesthesiologists (MDAs). We examine how the relative numbers of these two types of anesthesia providers, and differences in regulation, affect the earnings of CRNAs, and the extent of supervision of CRNAs by MDAs. We find that both the earnings, and the likelihood of medical supervision of CRNAs, are closely determined by their market share. As the market share of CRNAs increases from 0% to 50%, the gains to MDAs from restricting competition increase; over this range the likelihood that CRNAs are supervised increases and their expected earnings decline. However, as the CRNAs’ market share increases beyond 50%, the costs to MDAs of anticompetitive measures become too large, therefore, the probability of supervision declines, and the earnings of CRNAs increase.
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42

Manchikanti, Laxmaiah. "CMS Proposal for Interventional Pain Management by Nurse Anesthetists: Evidence by Proclamation with Poor Prognosis." Pain Physician 5;15, no. 5;9 (2012): E641—E664. http://dx.doi.org/10.36076/ppj.2012/15/e641.

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The Office of Inspector General (OIG), Department of Health and Human Services (HHS), in a 2009 report, showed that unqualified nonphysicians performed 21% of the services. These nonphysicians did not possess the necessary licenses, certifications, credentials, or training to perform the services. Since the time the medical profession was founded, advances in treatments and technology, as well as educational and training standards, have promoted a desire to go beyond the basic scope of practice. Many have sought to broaden the scope of practice through legislative efforts and proclamation rather than education and training. In 2001, President Clinton signed into law a rule that permitted states to “opt out” of the Centers for Medicare and Medicaid Services’ (CMS) requirement for nurse anesthetists to be supervised by any physician. Since then, 17 states have adopted this rule. While it was originally intended to help rural areas improve access to care, the opt out rule essentially supports any hospital or organization that seeks to make a profit or cut costs by allowing nurse anesthetists to function as physicians. With the implementation of sweeping health care regulations under the Affordable Care Act (ACA, also popularly known as Obamacare), the future of nurses and other professionals has been empowered. In fact, it has been proposed that medical training may be reduced by 30%, which will in their minds equalize training between nonphysicians and physicians. In 2010, the Federal Trade Commission (FTC) issued an opinion exerting their power to empower CRNAs with unlimited practice, with threats to opposing parties. In the 2013 proposed physician payment rule, CMS is proposing that CRNAs may perform interventional pain management services. Interventional pain management is a medical discipline with defined interventional techniques to be performed by professionals who are well trained and qualified. Without considering the consequences of the lack of education and training qualifications for CRNAs to offer interventional techniques, the FTC issued their opinion and CMS proposed to expand these practice patterns with a policy of improved access and reduced cost. However, in reality, the opposite will happen and will increase fraud, reduce access due to inappropriate procedures, and increase complications, all as a result of privileges by legislation without education. The CMS proposal for interventional pain management by nurse anesthetists is a proclamation with a poor prognosis. Key words: Interventional pain management, interventional techniques, certified registered nurse anesthetists, evidence-based medicine, fraud and abuse, education and training.
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43

Hoyem, Ruby L., Jihan A. Quraishi, Lorraine Jordan, and Kelly L. Wiltse Nicely. "Advocacy, Research, and Anesthesia Practice Models: Key Studies of Safety and Cost-Effectiveness." Policy, Politics, & Nursing Practice 20, no. 4 (2019): 193–204. http://dx.doi.org/10.1177/1527154419874410.

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The practice of anesthesia includes multiple competing practice models, including services delivered by anesthesiologists, independent practice by certified registered nurse anesthetists (CRNAs), and team-based approaches incorporating anesthesiologist supervision or direction of CRNAs. Despite data demonstrating very low risk of death and complications associated with anesthesia, debate among professional societies and policymakers persists over the superiority or equivalence among these models. The American Society of Anesthesiologists uses published findings as evidence for claims that anesthesia is safer when anesthesiologists lead in providing care. The American Association of Nurse Anesthetists cites its own research on safety and cost-efficiency outcomes to defend against these claims. We review and critique studies of the safety outcomes and cost-effectiveness of anesthesia delivery that have been cited in the Federal Trade Commission comment letters related to competition in health care, where each profession has laid out their case for how they ought to be recognized in the market for anesthesia services. The Federal Trade Commission has a role in protecting consumers from anticompetitive conduct that has the potential to impact quality and cost in health care. Thus, it is important to evaluate the evidence used to make claims about these topics. We argue that while research in this area is imperfect, the strong safety record of anesthesia in general and CRNAs in particular suggest that politics and professional interests are the main drivers of supervision policy in anesthesia delivery.
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44

Posner, Karen L., and Peter R. Freund. "Trends in Quality of Anesthesia Care Associated with Changing Staffing Patterns, Productivity, and Concurrency of Case Supervision in a Teaching Hospital." Anesthesiology 91, no. 3 (1999): 839. http://dx.doi.org/10.1097/00000542-199909000-00037.

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Background The authors used continuous quality improvement (CQI) program data to investigate trends in quality of anesthesia care associated with changing staffing patterns in a university hospital. Methods The monthly proportion of cases performed by solo attending anesthesiologists versus attending-resident teams or attending-certified registered nurse anesthetist (CRNA) teams was used to measure staffing patterns. Anesthesia team productivity was measured as mean monthly surgical anesthesia hours billed per attending anesthesiologist per clinical day. Supervisory ratios (concurrency) were measured as mean monthly number of cases supervised concurrently by attending anesthesiologists. Quality of anesthesia care was measured as monthly rates of critical incidents, patient injury, escalation of care, operational inefficiencies, and human errors per 10,000 cases. Trends in quality at increasing productivity and concurrency levels from 1992 to 1997 were analyzed by the one-sided Jonckheere-Terpstra test. Results Productivity was positively correlated with concurrency (r = 0.838; P<0.001). Productivity levels ranged from 10 to 17 h per anesthesiologist per clinical day. Concurrency ranged from 1.6 to 2.2 cases per attending anesthesiologist. At higher productivity and concurrency levels, solo anesthesiologists conducted a smaller percentage of cases, and the proportion of cases with CRNA team members increased. The patient injury rate decreased with increased productivity levels (P = 0.002), whereas the critical incident rate increased (P = 0.001). Changes in operational inefficiency, escalation of care, and human error rates were not statistically significant (P = 0.072, 0.345, 0.320, respectively). Conclusions Most aspects of quality of anesthesia care were apparently not effected by changing anesthesia team composition or increased productivity and concurrency. Only team performance was measured; the role of individuals (attending anesthesiologist, resident, or CRNA) in quality of care was not directly measured. Further research is needed to explain lower patient injury rates and increases in critical incident reporting at higher concurrency and productivity levels.
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Davies, Adam, Monaghan W. Patrick, and Hogan Gerard. "Implementing an educational program to increase preoperative screening for obstructive sleep apnea using the stop-bang questionnaire." International Journal of Advanced Nursing Studies 5, no. 1 (2016): 56. http://dx.doi.org/10.14419/ijans.v5i1.5551.

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<p><strong>Background:</strong> Obstructive sleep apnea (OSA) is a potentially fatal disease process that has been linked to higher rates of morbidity and mortality as well as increased perioperative complications. OSA is characterized by repetitive pauses in breathing during sleep. Greater than 92% of women and 82% of men who are plagued by moderate to severe sleep apnea are undiagnosed and may go unrecognized in the perioperative setting. The gap between a high prevalence of undiagnosed OSA in the adult population and the low level of clinical recognition has been well-documented. The term “STOP-BANG” is an acronym for eight independent elements predictive of OSA—three are OSA-related symptoms, three are physiological measurements, and two are patient characteristics.</p><p><strong>Methods:</strong> This project used a quasi-experimental design using a 16-question self-developed survey based on the technology acceptance model (TAM). Participants were asked to read an educational pamphlet on OSA and then complete the survey.</p><p><strong>Results:</strong> This study found strong evidence to suggest that among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs), those with higher scores on Perceived Ease of Use (PEOU), Perceived Usefulness (PU), and Attitude toward Use (AT), tend to have a higher Behavioral Intention to Use (BIU) the STOP-BANG screening tool.</p><p><strong>Conclusions:</strong> The results suggest that programs targeted at raising CRNAs’ and SRNAs’ PEOU, PU, and AT regarding the STOP-BANG questionnaire will culminate in increased use of the STOP-BANG screening tool. The use of this screening tool will detect patients previously unidentified as having OSA, and ultimately prevent perioperative complications associated with this disease.</p>
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Bowman, J. Patrick, Michael P. Nedley, Kimberly A. Jenkins, and Charles R. Fahncke. "Pilot Study Comparing Nasal vs Oral Intubation for Dental Surgery by Physicians, Nurse Anesthetists, and Trainees." Anesthesia Progress 65, no. 2 (2018): 89–93. http://dx.doi.org/10.2344/anpr-65-02-07.

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The purpose of this article was to determine if pediatric dental treatment under general anesthesia utilizing orotracheal intubation takes longer than using nasotracheal intubation techniques. Twenty-six American Society of Anesthesiologists Physical Status Classification I and II pediatric dental patients, ages 2–8 years treated under general anesthesia, were assigned to 1 of 2 groups: (a) nasotracheal intubation (control, n = 13), (b) orotracheal intubation (experimental, n = 13). Times for intubation, radiographic imaging, and dental procedures, as well as total case time were quantified. Data were collected on airway difficulty, numbers of providers needed for intubation, intubation attempts, and intubation trauma. There was a significant difference in mean intubation time (oral = 2.1 minutes versus nasal = 6.3 minutes; p < .01). There was no difference in mean radiograph time (oral = 4.2 minutes versus nasal = 3.4 minutes; p = .144), and overall radiograph image quality was not affected. There was no difference in dental procedure time (p = .603) or total case time (p = .695). Additional providers were needed for intubation and more attempts were required for nasotracheal intubation versus orotracheal intubation (6 additional providers/22 attempts vs 0 additional providers/15 attempts, p < .01 and p < .05, respectively). Nine of 13 nasotracheal intubations were rated as traumatic (69%) versus 0 of 13 for orotracheal intubations (0%) (p < .01). In 7/9 orotracheal intubation cases (78%), the tube was not moved during treatment (p < .01). Orotracheal intubation does not increase case time, does not interfere with radiographic imaging, and is less traumatic for the patient when performed by physician anesthesiologists, emergency and pediatric medicine physician residents, certified registered nurse anesthetists, and student nurse anesthetists, all with variable nasotracheal intubation experience.
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47

Abouleish, Amr E., Donald S. Prough, and Rakesh B. Vadhera. "Influence of the Type of Anesthesia Provider on Costs of Labor Analgesia to the Texas Medicaid Program." Anesthesiology 101, no. 4 (2004): 991–98. http://dx.doi.org/10.1097/00000542-200410000-00026.

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Background The Texas Medicaid Program (Medicaid) defines billable time for labor analgesia as face-to-face time; therefore, anesthesia providers determine billed time. The authors' goal was to determine the influence of anesthesia providers on labor analgesia costs billed to Medicaid. Methods Under the Freedom of Information Act, Medicaid provided data on claims paid for 6 months in 2001 for labor analgesia administered during the course of a vaginal delivery. Claims were either time based (codes 00946 or 00955) or a flat fee (codes 26311 or 26319). Using modifiers, the authors grouped time-based claims as either anesthesiologist group or certified registered nurse anesthetist (CRNA) group. The cost to Medicaid was based on the 2001 fee schedule. The conversion factor was 18.21 USD per American Society of Anesthesiologists unit. The flat-fee reimbursement was 152.50 USD. CRNA services were paid at 85% of the fee schedule. Average time per time claim, percent of providers with more than 4 h of billed time, and cost per claim were determined for each group. Providers with more than 120 claims (> 20 claims/month) were considered high-volume. Results The database included 21,378 claims (anesthesiologist group: 12,698 claims from 219 providers; CRNA group: 8,680 claims from 117 providers). For time-based claims, the average time per case was significantly higher in the CRNA group (146 min) than in the anesthesiologist group (105 min). The CRNA group cost to Medicaid (225.11 USD) was 19% more per claim than the anesthesiologist group (189.26 USD). The difference in cost per claim was greater among high-volume providers--213.10 USD for the CRNA group versus 168.76 USD for the anesthesiologist group. If a flat-fee program were instituted using the average cost per claim for all groups (203.81 USD), the Texas Medicaid program would save more than 500,000 USD annually. Conclusions The costs of labor analgesia billed to Texas Medicaid were 19% to 26% less per patient when provided by anesthesiologists than by CRNAs, despite lower per-unit reimbursement of CRNAs.
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48

Lennon, Erin. "The Advanced Practice Provider in Federal Disaster Medical Response: An American Experience." Prehospital and Disaster Medicine 34, s1 (2019): s100. http://dx.doi.org/10.1017/s1049023x1900205x.

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Introduction:Advanced Practice Providers (APP) are utilized in the United States National Disaster Medical System (NDMS) and consist of Certified Registered Nurse Anesthetists (CRNA), Nurse Practitioners (NP), and Physician Assistants (PA). They fill a critical role as Medical Officers in the Federal Disaster Medical Response on both Disaster Medical Assistance Teams (DMAT), Trauma & Critical Care Teams (TCCT), and United States Public Health Service (USPHS). DMAT teams and components of TCCT and USPHS responded to National Security Special Events, multiple natural disasters over the past two years including prolonged hurricane response in 2017 and 2018. The APPs were heavily utilized in key roles throughout the responses with much success.Aim:To explain how APPs are a vital component to US Federal Disaster Medical Response and are able to fill a multitude of roles as Medical Officers.Method:We used qualitative data from APPs in the US NDMS system illustrating what roles they filled during recent disaster responses.Results:The APPs were key components to the US NDMS response to disasters in the US and US territories by providing direct medical care as APPs, aid in medical evacuation, triage, healthcare administration, and medical infrastructure evaluations.Discussion:The APP is essential in the US Federal Disaster Medical Response and future research would be to obtain quantitative data on APPs in the U.S. NDMS. With increasing natural and man-made disasters affecting more people across the world annually, the increasing global population, and expected international health care worker shortages, APPs can be part of the overall solution to Medical Officer shortfalls and other key components in future disaster responses throughout the world. As APPs are not widely utilized worldwide, there will need to be education on what APP training is and how they can be utilized in areas not familiar with their abilities.
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Manchikanti, Laxmaiah. "Proposed Physician Payment Schedule for 2013: Guarded Prognosis for Interventional Pain Management." Pain Physician 5;15, no. 5;9 (2012): E615—E627. http://dx.doi.org/10.36076/ppj.2012/15/e615.

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As happens every year, on July 1, 2012, the Centers for Medicare and Medicaid Services issued a proposed policy and payment rate for services furnished under the Medicare physician fee schedule for 2013. The proposed rule would provide certified registered nurse anesthetists to practice independent interventional pain management. Other issues, though no less important, include a 27% sustainable growth rate formula cut in reimbursement, along with a 2% sequester, which could lead to a potential cut of 29%. Since the inception of Medicare programs in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. The sustainable growth rate was enacted in 1997 to determine physician payment updates under Medicare Part B. Its intent was to reduce Medicare physician payment updates to offset the growth and utilization of physician services that exceed gross domestic product growth. This is achieved by setting an overall target amount of spending for physicians’ services and adjusting payment rates annually to reflect differences between actual spending and the spending target. Since 2002, the sustainable growth rate has annually been used to recommend reductions in Medicare reimbursements. Payments were cut in 2002 by 4.8%. Since then, Congress has intervened on multiple occasions to prevent additional cuts from being imposed. In this manuscript, we will describe important proposed changes to the physician fee schedule. Additionally, the impact of multiple changes on interventional pain management will be briefly described. Key words: Health policy, physician payment policy, physician fee schedule, Medicare, sustained growth rate formula, interventional pain management, regulatory reform.
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Barry, N'Diris, Joshua C. Uffman, Dmitry Tumin, and Joseph D. Tobias. "Preliminary Indications for the Use of Sugammadex After Its Addition to a Formulary at a Tertiary Care Children's Hospital." Journal of Pediatric Pharmacology and Therapeutics 23, no. 1 (2018): 48–53. http://dx.doi.org/10.5863/1551-6776-23.1.48.

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OBJECTIVES Neuromuscular blocking agents (NMBAs) are administered to facilitate endotracheal intubation and provide skeletal muscle relaxation in surgical procedures. Sugammadex (Bridion) recently received approval by the United States Food and Drug Administration for reversal of rocuronium and vecuronium-induced neuromuscular blockade thereby providing an alternative to acetylcholinesterase inhibitors such as neostigmine. This quality improvement analysis sought to investigate the clinical reasons and common clinical perceptions for choosing sugammadex over neostigmine to reverse NMBAs. METHODS One hundred cases were reviewed where sugammadex was used for neuromuscular blockade reversal in the operating room. Cases were identified from electronic medical record reports. Anesthesia providers responsible for administering sugammadex were interviewed to obtain rationales for sugammadex use in the perioperative setting. Responses were reviewed to identify distinct reasons for using sugammadex. Two independent raters ranked the reasons according to prevalence. The study was exempt from Institutional Review Board approval as a quality improvement (QI) project. RESULTS Forty-two anesthesia providers (15 Certified Registered Nurse Anesthetists, 5 anesthesiology trainees, and 22 attending anesthesiologists) were interviewed to identify reasons why sugammadex was administered intraoperatively in 100 surgical cases (69/31 male/female patients, age 9.4 ± 6.5 years). The author identified the top 19 common reasons respondents chose to use sugammadex for each case, and independent raters reviewed the response summaries for those 19 primary reasons sugammadex was used. The most common reasons for choosing sugammadex were: 1) beneficial pharmacokinetics of the agent; 2) sugammadex's perceived superior efficacy over neostigmine; and 3) concerns regarding adverse effects of neostigmine and/or the anticholinergic agent. CONCLUSIONS Sugammadex has recently been introduced for clinical use to reverse NMBAs at our institution. Primary reasons and perceptions for its use over neostigmine included a limited adverse effect profile, a greater sense of control and predictability of patients' response, and a limited incidence of residual neuromuscular blockade.
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