The role of Certified Registered Nurse Anesthetists in the United States

Matsusaki, Takashi; Sakai, Tetsuro

doi:10.1007/s00540-011-1193-5

Cited by 27 publications

(17 citation statements)

References 10 publications

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“…For example, the use of certified nurse anesthetists to deliver anesthesia care has been prevalent for over a century. Nurse anesthetists have consistently demonstrated efficacy and safety with high provider satisfaction and acceptance[44]. Consequently, expanding the role of non-physicians into endoscopy would not limit the role of gastroenterologists, but rather allow them to increase services and access and further allow gastroenterologists to focus their attention on more complex and demanding procedures/cases.…”

Section: Discussionmentioning

confidence: 99%

Non-physician performance of lower and upper endoscopy: a systematic review and meta-analysis

et al. 2014

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Background and study aims Demand for endoscopic procedures worldwide has increased while the number of physicians trained to perform endoscopy has remained relatively constant. The objective of this study was to characterize lower and upper endoscopic procedures performed by non-physicians. Patients and methods Bibliographical searches were conducted in Medline, EMBASE, and Cochrane library databases. Studies were included if patients underwent flexible sigmoidoscopy, colonoscopy or upper endoscopy by a non-physician (nurse, nurse practitioner, physician assistant) and had outcome measures reported (polyps, adenomas and/or cancer detected, adverse events). Pooled rates were calculated for specific outcomes and rate ratios were determined for selected comparison groups. Results The majority of studies included nurses who performed flexible sigmoidoscopies for colorectal cancer screening. Nurses and nurse practitioners/physician assistants who performed flexible sigmoidoscopies had a pooled polyp detection rate of 9.9% and 23.7%, adenoma detection rate of 2.9% and 7.2%, colorectal cancer detection rate of 1.3% and 1.2% and an adverse event rate of 0.3 and 0 per 1,000 sigmoidoscopies, respectively. There was no significant difference between polyp and adenoma detection rates in studies comparing nurses or nurse practitioners/physician assistants with physicians performing sigmoidoscopy. Among studies of non-physicians performing colonoscopies (n=3), the pooled adenoma detection rate was 26.4%, cecal intubation rate of 93.5% and an adverse event rate of 2.2/1,000 colonoscopies. Of the few studies examining upper endoscopies 99.4% of upper endoscopy procedures performed by nurses were successful with no reported adverse events. Conclusion Available studies in the literature suggest that non-physicians perform endoscopic procedures, especially lower endoscopies, with outcomes and adverse events in line with physicians.

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Section: Discussionmentioning

confidence: 99%

Non-physician performance of lower and upper endoscopy: a systematic review and meta-analysis

et al. 2014

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“…However, as nurse anesthetist's roles increase and they are given more autonomy, their involvement in the care continuum of surgical patients will also evolve and increase [38]. For example, in the United States there are 16 states (including the authors') that allow CRNAs to practice independently without medical supervision [39]. As a result, including CRNAs and SRNAs in the evaluation of PACU items seemed appropriate and important.…”

Section: Discussionmentioning

confidence: 99%

Information needs for the OR and PACU electronic medical record

et al. 2014

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SummaryObjective: The amount of clinical information that anesthesia providers encounter creates an environment for information overload and medical error. In an effort to create more efficient OR and PACU EMR viewer platforms, we aimed to better understand the intraoperative and post-anesthesia clinical information needs among anesthesia providers. Materials and Methods: A web-based survey to evaluate 75 clinical data items was created and distributed to all anesthesia providers at our institution. Participants were asked to rate the importance of each data item in helping them make routine clinical decisions in the OR and PACU settings.Results: There were 107 survey responses with distribution throughout all clinical roles. 84% of the data items fell within the top 2 proportional quarters in the OR setting compared to only 65% in the PACU. Thirty of the 75 items (40%) received an absolutely necessary rating by more than half of the respondents for the OR setting as opposed to only 19 of the 75 items (25%) in the PACU. Only 1 item was rated by more than 20% of respondents as not needed in the OR compared to 20 data items (27%) in the PACU. Conclusion: Anesthesia providers demonstrate a larger need for EMR data to help guide clinical decision making in the OR as compared to the PACU. When creating EMR platforms for these settings it is important to understand and include data items providers deem the most clinically useful. Minimizing the less relevant data items helps prevent information overload and reduces the risk for medical error.

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“…From the 36,000 Certified Registered Nurse Anesthetists (CRNAs) and 42,330 anesthesiologists registered as anesthetic care providers in the United States in 2007, approximately 65% of the CRNAs practice in collaboration with anesthesiologists. Such use of the CRNA system in the United States seems to be attributed to the reimbursement of CRNA care [8]. Therefore, measuring the economic value of anesthetic care by nurse anesthetists will be the basis for establishing a reimbursement system for nurse anesthetists and using the Korean Nurse Anesthetist System.…”

Section: Discussionmentioning

confidence: 99%

“…Certified Registered Nurse Anesthetists in the United States are paid the cost for their anesthetic practice [8], but KNAs do not warrant the cost of anesthetic care in Korea. In order to improve the nurse practitioner system in anesthetic practices, it is imperative to enact legislation that implements cost policies for high quality anesthetic nursing care.…”

Section: Introductionmentioning

confidence: 99%