re: Wisconsin Hospital Replaces All Anesthesiologists with CRNAs

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Thank you, professor. Sadly, however, the surgeon posting in this thread who works with independent CRNAs feels like this is all ultimately the surgeon’s responsibility.

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Which is why I agree with you that a surgeon shouldn’t be responsible for supervision of any CRNA. They just don’t know what we know about anesthesia and we know more than you think we know.

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I think you’re overestimating the average hospital administrator.

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Touché

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The substandard care part is interesting. I haven’t read any of those studies because it doesn’t affect me at all. I’m assuming you can link a few though?

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sure the link is a summary of recent studies that argue both sides of the argument. it considered the stengths and weaknesses of the studies as well as the conclusions. Independently funded studies with more appropriate parameters and data sets conclude anesthesiologists provide higher standard of care vs unsupervised cRNA. (this is a 'well duh' conclusion)

the studies that suggest cRNA provide equivalent care include cRNA's under supervision of anesthesiologist, are funded by nursing groups using more biased data sets that fail to account for differences in patient health and difficulty of the case.
LINK

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I find it odd that these large healthcare organizations who are incredibly risk averse would move to a 100% CRNA model of it was in fact significantly more risky.

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that is because they face less liability and repercussions when a nurse is negligent vs a physician.

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that is because they face less liability and repercussions when a nurse is negligent vs a physician.

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This is the dumbest thing that you continue to repeat. Currently a supervised nurse may have less liability but that’s only because there can be some liability placed on a physician and the physician has deeper pockets. This is no different than residents being named in malpractice suits but then getting dropped or being found liable for a significantly smaller portion of the monetary damages. The resident could even be at fault and the lawyers go after the attending because that’s where the money is. But we aren’t talking about supervised nurses any more. We are talking about a hospital full of independent CRNAs. Assuming that the surgeon did not commit malpractice, then the judgement will come against the CRNA and the CRNA alone (though I still think a smart patient will try and place some liability on the hospital that fired all the MD/DOs too). They do not face any less financial liability in this case. And the hospital could actually have greater financial liability.

The Unsupervised CRNA Model Threatens Patient Safety

Timely article for this thread. From medical malpractice attorney and former hospital administrator.

High points:
“Over the years, the financial motivation spread to PAs, NPs, and, definitely, nurse anesthetists, and their lobbying groups. They funded bogus studies that concluded that their quality of care was equivalent—or better—than that of physicians, who generally have far more training.

To be clear, I’m not trying to diminish the important role that PAs, NPs, and CRNAs play in health care. They’re capable to provide health care services within their training, licensure, and experience. When they try to take on responsibilities beyond their training and competence, though, it’s a danger to patients. That’s why I believe that some PAs, NPs, and CRNAs—with the cooperation of hospital and practice group leaders—are selling patients a phony bill of goods.

There’s nowhere that this is more evidence than in the complex, demanding field of anesthesia care.

Anesthesiology has traditionally been the highest paid medical specialty in health care. There’s a reason for this. It requires significant training. Anesthesiologists are airway experts who know how to administer anesthetic medications to put you to sleep and bring you safely back. They’re also experts in critical care medicine.

CRNAs don’t have equivalent training and experience. According to the American Society of Anesthesiologists, physician anesthesiologist have 12,000–16,000 of clinical patient care in their curriculum, while CRNAs have just 1,650 hours. It’s that lack of additional training that makes the average CRNA less able to handle an emergency. And anesthesia emergencies are such that even a short delay in rendering the correct medical response can mean the difference between life and death, or brain injury or recovery....

From my experience in handling many anesthesia medical malpractice cases, I have these take aways to share:

• CRNAs are a lot cheaper than anesthesiologists for hospitals and surgery centers to hire.

• CRNAs lack equivalent or comparable training to physician anesthesiologists for handling anesthesia emergencies.

• When there’s an OR emergency, most CRNAs panic and focus on getting the anesthesiologist into the OR for help.

• In medical malpractice litigation, most CRNAs subtly shift blame on anesthesiologists involved in medical direction or supervision.“

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Now midwives fill the gap

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They certainly do not. Comparing an obstetrician to a midwife is insanity and completely ignorant. What a complete joke and an insult to women’s health.

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When there’s an OR emergency, most CRNAs panic and focus on getting the anesthesiologist into the OR for help.

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Completely subjective and bullsh*t. To settle this, I’d love to have John Q Public be able to follow a case at my hospital once the anesthesiologist leaves after getting consent. They would be educated about what really happens and who is delivering the care. Facts are facts.

Just finished my first case. Never saw an anesthesiologist.

The public is so naive to the truth.

AMS doesn’t know what he doesn’t know.