AANA - Quality of Nurse Anesthesia Practice

Quality of Nurse Anesthesia Practice

Nurse Anesthetists have provided high quality anesthesia care for more than a century. Certified Registered Nurse Anesthetists (CRNAs) have the legal authority to practice anesthesia in the United States, administering and managing every aspect of the anesthetic process, from preanesthesia assessment and evaluation through the recovery phase of care.

Studies have shown a dramatic reduction in anesthesia mortality rates to approximately 1 per 240,000 anesthetics. In 1990, the Centers for Disease Control and Prevention (CDC) proposed to undertake research on morbidity and mortality in anesthesia; however, after review of preliminary data, the CDC concluded that the morbidity and mortality rates in anesthesia were too low to warrant a multi-million dollar study. Further, no studies to date have demonstrated that there is a difference in anesthesia patient care outcomes based on type of anesthesia provider, that is, a nurse anesthetist or anesthesiologist. This conclusion was recently confirmed in 1994 by the Minnesota Department of Health, which completed a legislatively mandated study concerning anesthesia care in that state. The department concluded that "there are no studies, either national in scope or Minnesota-specific, which conclusively show a difference in patient outcomes based on type of provider."

The American Association of Nurse Anesthetists (AANA) has been at the forefront of establishing clinical practice standards. The AANA was the first professional organization to endorse the Harvard Minimal Monitoring Standards on Anesthesia Care. Subsequently, AANA has issued even more explicit patient monitoring standards for anesthesia. In its capacity as the professional organization representing CRNAs, the AANA has developed standards of nurse anesthesia practice and postanesthesia care, as well as guidelines for obstetrical analgesia and anesthesia, waste gas management, and infection control. These documents are acknowledged by other nursing, medical, and allied health specialty groups.

The AANA fosters the participation and support of CRNAs in continuing education programs and practice advances and improvements relating to quality of care, patient safety research, patient satisfaction surveys, and technology development. The AANA also affords guidance to its members for developing and/or participating in peer review and risk management activities within health care institutions. A risk management guide for nurse anesthetists is published by the AANA. The AANA is a patron member of the Anesthesia Patient Safety Foundation (APSF) and has representatives appointed that serve on the Board of Directors and Editorial Board of APSF. The AANA holds membership on the Hospital Professional Technical Advisory Committee of the Joint Commission on Accreditation of Healthcare Organizations.

St. Paul Fire and Marine Insurance Company is the largest writer of medical malpractice insurance in the country and is also the largest provider of professional liability insurance for CRNAs as well. The St. Paul insurance company has advised AANA that, to its knowledge, there is no evidence that physicians (such as surgeons) working with CRNAs have a higher rate of claims made against insurance companies than physicians working with anesthesiologists. In 1995, the St. Paul insurance company reported that medical professional liability insurance rates for its insured nurse anesthetist policyholders decreased, on an average, countrywide basis, between 6 to 13% each year from 1988 to 1993 and have been stable through 1996.

References
Eichhorn JH. Prevention of intraoperative anesthesia accidents and related severe injury through safety monitoring. Anesthesiology. 1989; 70:572-577.
Anesthesia Practices Study. St. Paul, Minnesota: Minnesota Department of Health. (Study mandated by the 1994 MinnesotaCare Act.) January 1995.
Bechtold AA. Committee on anesthesia study of anesthesia-related deaths 1969-1976, North Carolina Medical Journal. 1981;42:253.
Forrest WH. Outcome: the effect of the provider. In Hirsch RA, Forrest WH, Orkin FK, et al, eds. Health Care Delivery in Anesthesia. Philadelphia: George F. Stickley Company. 1980.
Harvard Minimal Monitoring Standards on Anesthesia Care, Journal of the American Medical Association. 1986.
National Academy of Sciences, National Research Council, House Committee Print No. 36, Health Care for American Veterans. June 7, 1977; 156.
The St. Paul Medical Services. Nurse Anesthetists Update. July 1995.U.S. House of Representatives, Committee on Armed Services Report on H.R. 1748, Department of Defense Authorization Act for Fiscal Year 1988-89, pages 208-209.

Quality of Nurse Anesthesia Practice

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