SCHAUMBURG, Ill. – The American Society of Anesthesiologists (ASA) is extremely gratified by the U.S. Department of Veterans Affairs (VA) decision to reverse its proposal to replace the department’s physician anesthesiologists with nurses in VA health care facilities. If implemented, the proposal would have fundamentally changed the delivery of surgical anesthesia care for Veterans. The final rule was posted to the Federal Register today. In it, the VA will maintain its current physician-led, team-based model of care under which physician anesthesiologists and nurse anesthetists work together to provide high-quality and safe anesthesia care.
“This was the right decision for our nation’s Veterans and for safe patient care,” said ASA President Jeffrey Plagenhoef, M.D. “We’re thrilled with the VA’s decision to remove anesthesia from the new Advanced Practice Registered Nurses rule. We commend VA’s leadership for their recognition that the operating room is a unique care setting and that surgery and anesthesia are inherently dangerous requiring physician leadership. This is true for anyone, but especially for our nation’s Veterans, given many of them have multiple medical conditions that put them at greater risk for complications during and after surgery and anesthesia.”
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
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS®
Founded in 1905, the American Society of Anesthesiologists (ASA®) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount.