ASA commends the VA leadership for their evidence-based, decision-making process. VA’s own internal Quality Enhancement Research Initiative (QUERI) study of this issue titled “Evidence Brief: The Quality of Care Provided by Advanced Practice Registered Nurses” raised significant questions about the safety of the “solo CRNA” or nurse-only model of anesthesia. After reviewing existing studies, even self-funded nursing advocacy studies, QUERI concluded the evidence did not prove it would be safe to implement nurse-only models of anesthesia for VA, specifically questioning “whether more complex surgeries can be safely managed by CRNAs.”
The VA’s final rule assures the Department’s alignment with current laws in 46 states and the District of Columbia, which all require physician involvement for anesthesia care. Removing physician anesthesiologists would lower the standard of care and jeopardize lives.
Initially, the VA had considered a policy that would remove physician anesthesiologists from the operating room as part of a proposal to abandon physician-led, team-based models of care in VA and permit so-called “full practice authority” or nurse-only models of care for all VA advanced practice registered nurses, including nurse anesthetists.
The proposed rule, which was published in the Federal Register in May, attracted an unprecedented outpouring from the public, a record for VA-related issues as well as a record for the most comments posted in 2016. More than 104,000 comments were submitted in support of maintaining VA’s current physician-led, team-based anesthesia policy, of which some 11,000 were submitted by Veterans, and over 14,000 were submitted by family members of Veterans.
ASA with the support of Veterans and Military Service Organizations like the Association of the United States Navy (AUSN) urged VA leadership to reject poorly-designed, advocacy studies self-funded by the American Association of Nurse Anesthetists that claimed no differences between the care provided by physician anesthesiologists and nurse anesthetists. No independent, methodologically sound studies exist that show nurses can ensure the same outcomes as physician anesthesiologists.
“Nurse anesthetists are not the same as physician anesthesiologists - 8-9 years of postgraduate education and 14,000 to 16,000 hours of clinical training undertaken by physician anesthesiologists makes a difference for patients,” Dr. Plagenhoef said. “As we see in operating rooms throughout the country every day, when seconds count, physician anesthesiologists save lives.”
We salute VA for preserving the proven anesthesia team-based care model where physicians and nurses work together to provide the best care possible for our nation’s Veterans.
More information about the rule and physician anesthesiologists is available at safevacare.org.