Effectiveness of the Non‐Medical Surgical Assistant measured by patient outcome assessment

Abstract

Aims To investigate effectiveness of the nurse clinician as a Non‐Medical Surgical Assistant compared with the Medical Surgical Assistant. Background Non‐Medical Surgical Assistants are clinicians who are not medical practitioners. The surgical assistant works directly with the primary surgeon intraoperatively. Design A pragmatic, retrospective, observational study on patients undergoing Laparoscopic Inguinal Hernia Repair or Primary Unilateral Total Hip Arthroplasty. Each patient received intraoperative care from a consultant surgeon and a Medical Surgical Assistant or Non‐Medical Surgical Assistant. All surgical assistants were registered with the Australian Health Practitioner Regulation Agency. Methods Data were collected between 01/07/2014 and 30/06/2017. The effect that surgical assistant choice had on patient outcomes was estimated using regression statistical models. Six dependent variables, including length of stay, for clinical outcome assessment were specified. Results/Findings The groups were equivalent in age, gender, and American Society of Anaesthesiologists scores. There were more emergency procedures in the Medical Surgical Assistant group and more hip surgery in the Non‐Medical Surgical Assistant group. Patient outcome assessment showed no statistically significant differences for surgical assistant types. Conclusion The nurse clinician in the role of Non‐Medical Surgical Assistant was shown to be effective with equivalent patient outcomes compared with the Medical Surgical Assistant.

The non-medical surgical assistant and inequity in the Australian healthcare system

“…However, there are international and Australian data that demonstrates the NMSA has equivalent patient outcomes to the MSA. 14,[58][59][60][61][62][63] Patient outcomes investigated in the Australian data considered six dependent variables; time in the operating theatre, intraoperative time, admission to Intensive Care, length of stay, discharge destination and readmission within 28 days. The results showed no statistically significant difference and no clinically relevant difference between the MSA and NMSA.…”

“…13 Previous research has quantified that the NMSA is a safe and effective provider of surgical assisting care using the comparator of the medical surgical assistant (MSA). 14 Similarly, it has been established, through surveys of key stakeholders, the examination of peak professional bodies' position statements and a review of the law that the nurse practitioner (NP) and registered nurse (RN) are legitimate clinicians to perform the role of NMSA in Australia. [15][16][17] Due to inequity in the delivery of healthcare many first-world countries currently report differing access to healthcare.…”

The Perioperative Nurse Surgical Assitant (PNSA) of the future

“…Barriers to the broader uptake of the role are limited by the exclusion of the PNSA role from Medicare Benefits Scheme (MBS) funding for intraoperative surgical assistance. Currently MBS funding is only available to medical assistants 5,8,9 . Most PNSAs in Australia work within the private sector and are mentored by a surgeon who provides the financial remuneration for their specialist skills not currently covered by the MBS.…”

“…The pressure on the Australian health service from a growing and ageing population, increasing rates of chronic disease, rising costs and doctor shortages outside metropolitan areas is an area where APNs can meet essential needs for quality patient care and service delivery 8,15,16 . Shortages of doctors in rural and remote areas mean that RNs often act as doctor substitutes, requiring RNs to be multiskilled and to practice at an advanced level; this in turn is likely to lead to increased demand for the PNSA role 14,16 .…”

The legitimacy of the nurse practitioner as a non-medical surgical assistant: Historical evidence from Australia

“…There is evidence that the nurse NMSA is an effective alternative to the MSA and increases equity for the private sector surgical patient (Hains et al, 2020a(Hains et al, , 2020b. Healthcare facilities will credential multiple levels of nurses as NMSAs, however; consideration for competent practice is a Diploma (AQF level 5), a Bachelor's Degree (AQF level 7) or an autonomous advanced practice Master's Degree (AQF level 9) for the Enrolled Nurse (EN), RN or NP respectively (Thoun, 2011).…”