Current policy in the Department of Veterans Affairs (VA) directs physician-led team-based anesthesia care. This proven and consensus model of care provides Veterans the safe, high-quality care they have earned and deserve. The proposed VHA Nursing Handbook abandons a team-based model of anesthesia care that has consistently assured high-quality care for Veterans and replaces the model with a new, untested and unsupported anesthesia care model.
There are no independent studies to support the nurse-only model of anesthesia care as safe for Veterans. Research funded by the VA’s Office of Research and Development, Quality Enhancement Research Initiative (QUERI) concluded “recent publications promoting over-riding state scope-of-practice laws argue that a large body of evidence shows APRNs working independently provide the same quality of care as medical doctors. We found scarce long-term evidence to justify this position.” The report indicated that the evidence for full practice authority related to CRNAs was “insufficient” and at “high risk of bias.”
Further, the report examined frequently cited observational studies that used claims data to compare outcomes, looking at mortality and length of stay with respect to nurse anesthetist-only care versus care by a physician anesthesiologist. The examination concluded, “The results of these studies do not provide any guidance on how to assign patients for management by a solo CRNA, or whether more complex surgeries can be safely managed by CRNAs, particularly in small or isolated VA hospitals where preoperative and postoperative health system factors may be less than optimal. [emphasis added]”
“Full practice authority” or independent practice does not represent the “best of the private sector” in anesthesia care. The proposed rule would effectively eliminate the current model of team-based anesthesia care prevalent throughout the VA system and in most states. The majority of states specifically require the involvement of a physician in anesthesia care. Even among the so-called “Medicare opt-out states,” all but three states still recognize a state law or regulation providing for anesthesia to be delivered through supervision, collaboration or other team-based arrangement.
Ensure our Veterans receive the safe, high-quality health care they have earned and deserve by opposing efforts to lower the standard of surgical/anesthesia care within VA.