Advocacy, Research, and Anesthesia Practice Models: Key Studies of Safety and Cost-Effectiveness

2019 ◽  
Vol 20 (4) ◽  
pp. 193-204 ◽  
Author(s):  
Ruby L. Hoyem ◽  
Jihan A. Quraishi ◽  
Lorraine Jordan ◽  
Kelly L. Wiltse Nicely
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Federal Trade Commission ◽  
Nurse Anesthetists ◽  
Independent Practice ◽  
Certified Registered Nurse Anesthetists ◽  
Risk Of Death ◽  
Practice Models ◽  
American Society ◽  
American Society Of Anesthesiologists

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.

scholarly journals An updated mortality risk analysis of the post-pubertal undescended testis

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Ankur Shah ◽  
Paul J. Feustel ◽  
Jennifer Knuth ◽  
Charles Welliver
Keyword(s):  
Germ Cell Tumour ◽  
Cumulative Risk ◽  
Lifetime Risk ◽  
Risk Of Death ◽  
Increased Risk ◽  
Class 1 ◽  
Table Data ◽  
American Society ◽  
Standard Life ◽  
American Society Of Anesthesiologists

Introduction: The undescended testicle (UDT) presents a problem in post-pubertal (PP) men, as it carries an increased risk of developing a germ cell tumour (GCT). Management of the PP patient with an UDT must weigh the relative risk (RR) of perioperative mortality (POM) from orchiectomy against the lifetime risk of death from a GCT. Methods: The most recent data on GCT mortality were obtained from the National Centre for Health Statistics. Standard life tables were used to calculate the cumulative risk over a man’s lifetime based on age. The increased RR of GCT in men with UDT was determined by weighing the observed and expected rates from literature review. Life table data was then multiplied by the RR to define the risk of GCT in men with UDT. Data from patients undergoing similar risk surgical procedures, stratified by American Society of Anesthesiologists (ASA) class, was used to determine POM. Results: Lifetime risk of dying from GCT decreases with increasing age. POM exceeded risks of death from GCT for men after age 50.2 for ASA class 1 and age 35.4 for ASA class 2. Men with an ASA class higher than 2 have a higher risk of POM compared to GCT for all ages. Conclusions: We found different ages from previous reports at which observation is advised. We consider prophylactic orchiectomy only in men who are under 50.2 years if ASA class 1 and under 35.4 years if ASA class 2. Men with an ASA class 3 or higher should always undergo observation.

Comparison of Twitter Use of the American Society of Anesthesiologists and the American Association of Nurse Anesthetists

2019 ◽  
Vol 13 (6) ◽  
pp. 240-244
Author(s):  
Benjamin Chu ◽  
M. James Lozada ◽  
Emery Harris McCrory ◽  
Paloma Toledo ◽  
Matthew Antalek ◽  
...  
Keyword(s):  
American Association ◽  
Nurse Anesthetists ◽  
American Society ◽  
American Society Of Anesthesiologists

Obstetric Anesthesia Work Force Survey, 1981 versus 1992 

1997 ◽  
Vol 87 (1) ◽  
pp. 135-143 ◽  
Author(s):  
Joy L. Hawkins ◽  
Charles P. Gibbs ◽  
Miriam Orleans ◽  
Gallice Martin-Salvaj ◽  
Brenda Beaty
Keyword(s):  
Cesarean Section ◽  
Epidural Analgesia ◽  
General Anesthesia ◽  
Obstetric Anesthesia ◽  
The United States ◽  
Nurse Anesthetists ◽  
Regional Analgesia ◽  
American Hospital ◽  
American Society ◽  
American Society Of Anesthesiologists

Background In 1981, with support from the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists, anesthesia and obstetric providers were surveyed to identify the personnel and methods used to provide obstetric anesthesia in the United States. The survey was expanded and repeated in 1992 with support from the same organizations. Methods Comments and questions from the American Society of Anesthesiologists Committee on Obstetrical Anesthesia and the American College of Obstetricians and Gynecologists Committee on Obstetric Practice were added to the original survey instrument to include newer issues while allowing comparison with data from 1981. Using the American Hospital Association registry of hospitals, hospitals were differentiated by number of births per year (stratum I, > or = 1,500 births; stratum II, 500-1,499 births; stratum III, < 500 births) and by U.S. census region. A stratified random sample of hospitals was selected. Two copies of the survey were sent to the administrator of each hospital, one for the chief of obstetrics and one for the chief of anesthesiology. Results Compared with 1981 data, there was an overall reduction in the number of hospitals providing obstetric care (from 4,163 to 3,545), with the decrease occurring in the smallest units (56% of stratum III hospitals in 1981 compared with 45% in 1992). More women received some type of labor analgesia and there was a 100% increase in the use of epidural analgesia. However, regional analgesia was unavailable in 20% of the smallest hospitals. Spinal analgesia for labor was used in 4% of parturients. In 1981, obstetricians provided 30% of epidural analgesia for labor; they provided only 2% in 1992. Regional anesthesia was used for 78-85% (depending on strata) of patients undergoing cesarean section, resulting in a marked decrease in the use of general anesthesia. Anesthesia for cesarean section was provided by nurse anesthetists without the medical direction of an anesthesiologist in only 4% of stratum I hospitals but in 59% of stratum III hospitals. Anesthesia personnel provided neonatal resuscitation in 10% of cesarean deliveries compared with 23% in 1981. Conclusions Compared with 1981, analgesia is more often used by parturients during labor, and general anesthesia is used less often in patients having cesarean section deliveries. In the smallest hospitals, regional analgesia for labor is still unavailable to many parturients, and more than one half of anesthetics for cesarean section are provided by nurse anesthetists without medical direction by an anesthesiologist. Obstetricians are less likely to personally provide epidural analgesia for their patients. Anesthesia personnel are less involved in newborn resuscitation.

scholarly journals 30-day mortality following trauma and orthopaedic surgery during the peak of the COVID-19 pandemic

2020 ◽  
Vol 1 (7) ◽  
pp. 392-397 ◽  
Author(s):  
Paul N. Karayiannis ◽  
Veronica Roberts ◽  
Roslyn Cassidy ◽  
Alistair I. W. Mayne ◽  
Daryl McAuley ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Postoperative Mortality ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Specific Data ◽  
Risk Of Death ◽  
Deceleration Phase ◽  
Time Period ◽  
American Society ◽  
American Society Of Anesthesiologists

Aims Now that we are in the deceleration phase of the COVID-19 pandemic, the focus has shifted to how to safely reinstate elective operating. Regional and speciality specific data is important to guide this decision-making process. This study aimed to review 30-day mortality for all patients undergoing orthopaedic surgery during the peak of the pandemic within our region. Methods This multicentre study reviewed data on all patients undergoing trauma and orthopaedic surgery in a region from 18 March 2020 to 27 April 2020. Information was collated from regional databases. Patients were COVID-19-positive if they had positive laboratory testing and/or imaging consistent with the infection. 30-day mortality was assessed for all patients. Secondly, 30-day mortality in fracture neck of femur patients was compared to the same time period in 2019. Results Overall, 496 operations were carried out in 484 patients. The overall 30-day mortality was 1.9%. Seven out of nine deceased patients underwent surgery for a fractured neck of femur. In all, 27 patients contracted COVID-19 in the peri-operative period; of these, four patients died within 30 days (14.8%). In addition, 21 of the 27 patients in this group had a fractured neck of femur, 22 were over the age of 70 years (81.5%). Patients with American Society of Anesthesiologists (ASA) grade > 3 and/or age > 75 years were at significantly higher risk of death if they contracted COVID-19 within the study period. Conclusion Overall 30-day postoperative mortality in trauma and orthopaedic surgery patients remains low at 1.9%. There was no 30-day mortality in patients ASA 1 or 2. Patients with significant comorbidities, increasing age, and ASA 3 or above remain at the highest risk. For patients with COVID-19 infection, postoperative 30-day mortality was 14.8%. The reintroduction of elective services should consider individual patient risk profile (including for ASA grade). Effective postoperative strategies should also be employed to try and reduce postoperative exposure to the virus. Cite this article: Bone Joint Open 2020;1-7:392–397.

Procedural Sedation by Nonanesthesia Providers

2011 ◽  
pp. 49-61 ◽  
Author(s):  
Julia Metzner ◽  
Karen B. Domino
Keyword(s):  
Health Care Providers ◽  
Improve Patient Safety ◽  
Essential Elements ◽  
Procedural Sedation ◽  
Certified Registered Nurse Anesthetists ◽  
The Face ◽  
Sedation And Analgesia ◽  
American Society ◽  
Gi Radiology ◽  
American Society Of Anesthesiologists

Although anesthesiologists and certified registered nurse anesthetists (CRNAs) are experts in sedation/analgesia outside of the operating room (OOOR), extensive demand in the face of limited resources has resulted in sedation being routinely performed by nonanesthesia health care providers. Sedation/analgesia is administered for minor office and hospital procedures in a variety of areas, including gastroenterology (GI), radiology, cardiology, dentistry, and the emergency room. Given the extreme diversity of settings, it is understandable that procedural sedation and analgesia evolved to meet the unique needs of each of these specialties. However, to improve patient safety, the Joint Commission and the American Society of Anesthesiologists (ASA) issued standards that unify and standardize the various approaches across specialties and institutions.1 , 2 This chapter will briefly review the essential elements needed to develop a safe policy for sedation by nonanesthesia practitioners.

Takuo Aoyagi, Ph.D., American Society of Anesthesiologists Honorary Member

2021 ◽  
Vol 135 (4) ◽  
pp. 591-596
Author(s):  
Alexander A. Hannenberg
Keyword(s):  
Health Care ◽  
Pulse Oximetry ◽  
Honorary Member ◽  
Honorary Membership ◽  
American Society ◽  
American Society Of Anesthesiologists

Pulse oximetry has changed anesthesiology and all of health care. Its inventor is recognized with American Society of Anesthesiologists Honorary Membership this year. The authors explore his invention and its far-reaching impact.

scholarly journals 30-day mortality following trauma and orthopaedic surgery during the peak of the COVID-19 pandemic

2020 ◽  
Vol 1 (7) ◽  
pp. 392-397
Author(s):  
Paul N. Karayiannis ◽  
Veronica Roberts ◽  
Roslyn Cassidy ◽  
Alistair I. W. Mayne ◽  
Daryl McAuley ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Postoperative Mortality ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Specific Data ◽  
Risk Of Death ◽  
Deceleration Phase ◽  
Time Period ◽  
American Society ◽  
American Society Of Anesthesiologists

Aims Now that we are in the deceleration phase of the COVID-19 pandemic, the focus has shifted to how to safely reinstate elective operating. Regional and speciality specific data is important to guide this decision-making process. This study aimed to review 30-day mortality for all patients undergoing orthopaedic surgery during the peak of the pandemic within our region. Methods This multicentre study reviewed data on all patients undergoing trauma and orthopaedic surgery in a region from 18 March 2020 to 27 April 2020. Information was collated from regional databases. Patients were COVID-19-positive if they had positive laboratory testing and/or imaging consistent with the infection. 30-day mortality was assessed for all patients. Secondly, 30-day mortality in fracture neck of femur patients was compared to the same time period in 2019. Results Overall, 496 operations were carried out in 484 patients. The overall 30-day mortality was 1.9%. Seven out of nine deceased patients underwent surgery for a fractured neck of femur. In all, 27 patients contracted COVID-19 in the peri-operative period; of these, four patients died within 30 days (14.8%). In addition, 21 of the 27 patients in this group had a fractured neck of femur, 22 were over the age of 70 years (81.5%). Patients with American Society of Anesthesiologists (ASA) grade > 3 and/or age > 75 years were at significantly higher risk of death if they contracted COVID-19 within the study period. Conclusion Overall 30-day postoperative mortality in trauma and orthopaedic surgery patients remains low at 1.9%. There was no 30-day mortality in patients ASA 1 or 2. Patients with significant comorbidities, increasing age, and ASA 3 or above remain at the highest risk. For patients with COVID-19 infection, postoperative 30-day mortality was 14.8%. The reintroduction of elective services should consider individual patient risk profile (including for ASA grade). Effective postoperative strategies should also be employed to try and reduce postoperative exposure to the virus. Cite this article: Bone Joint Open 2020;1-7:392–397.

scholarly journals Prevalence of Potentially Distracting Noncare Activities and Their Effects on Vigilance, Workload, and Nonroutine Events during Anesthesia Care

2018 ◽  
Vol 128 (1) ◽  
pp. 44-54 ◽  
Author(s):  
Jason M. Slagle ◽  
Eric S. Porterfield ◽  
Amanda N. Lorinc ◽  
David Afshartous ◽  
Matthew S. Shotwell ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Nurse Anesthetists ◽  
Web Based ◽  
Anesthesia Providers ◽  
Academic Medical ◽  
Actual Care ◽  
Case Type ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background When workload is low, anesthesia providers may perform non–patient care activities of a clinical, educational, or personal nature. Data are limited on the incidence or impact of distractions on actual care. We examined the prevalence of self-initiated nonclinical distractions and their effects on anesthesia workload, vigilance, and the occurrence of nonroutine events. Methods In 319 qualifying cases in an academic medical center using a Web-based electronic medical chart, a trained observer recorded video and performed behavioral task analysis. Participant workload and response to a vigilance (alarm) light were randomly measured. Postoperatively, participants were interviewed to elicit possible nonroutine events. Two anesthesiologists reviewed each event to evaluate their association with distractions. Results At least one self-initiated distraction was observed in 171 cases (54%), largely during maintenance. Distractions accounted for 2% of case time and lasted 2.3 s (median). The most common distraction was personal internet use. Distractions were more common in longer cases but were not affected by case type or American Society of Anesthesiologists physical status. Workload ratings were significantly lower during distraction-containing case periods and vigilance latencies were significantly longer in cases without any distractions. Three distractions were temporally associated with, but did not cause, events. Conclusions Both nurse anesthetists and residents performed potentially distracting tasks of a personal and/or educational nature in a majority of cases. Self-initiated distractions were rarely associated with events. This study suggests that anesthesia professionals using sound judgment can self-manage nonclinical activities. Future efforts should focus on eliminating more cognitively absorbing and less escapable distractions, as well as training in distraction management.

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