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Statement on Clinical Privileges for the Non-Physician Anesthesia Provider

Developed by: Committee on Quality Management and Departmental Administration
Original Approval: October 18, 2023

Anesthesiology is the practice of medicine. It includes, but is not limited to, providing medical care to a patient before, during, and after a surgical, diagnostic, or therapeutic procedure that requires the administration of anesthetics and/or hemodynamic monitoring, regardless of patient or procedural complexity, as well as managing of systems and leading of personnel that support these activities.1

The practice of anesthesiology includes the preoperative evaluation, the diagnostic workup, the optimization of preexisting medical conditions prior to surgery, the decision to proceed with surgery, the prescribing of anesthetic care plans, the perioperative management of coexisting disease, the delivery of anesthetics, the determination and management of postoperative care requirements, the prevention and management of periprocedural complications, the practice of acute and chronic pain medicine, and the practice of critical care medicine. This care can only be personally provided, directed, or supervised by the physician anesthesiologist.2

Physician anesthesiologists are responsible for determining and delegating anesthesia delivery, monitoring, and appropriate tasks to qualified non-physician anesthesia practitioners.3  Such delegation must be consistent with local, state, and federal laws; regulations; policies; and medical staff organization bylaws. The ultimate responsibility for the patient's safety rests with the physician anesthesiologist.4 

The following statement is designed to assist healthcare organizations to develop a sound and rational approach to delineating clinical privileges to qualified non-physician anesthesia practitioners, i.e., anesthesiologist assistants and nurse anesthetists.5

  1. DEFINITIONS
    1. Credentials: The professional qualifications of a practitioner, including education, training, experience, and performance 
    2. Privileges: The clinical activities within a health care organization that a practitioner is permitted to perform based on the practitioner’s credentials  
    3. Credentialing: The process of documenting and reviewing a practitioner’s credentials  
    4. Privileging: The process of granting privileges by a health care organization to a practitioner for specific clinical activities based on a credentials review

  2. STATEMENT
    1. Initial requests for privileges by a non-physician anesthesia practitioner should reflect appropriate education, training, experience, performance, certification, and licensure, and should be considered and granted by the anesthesia service that is under the direction of a qualified doctor of medicine or osteopathy.9
      1. Education/training should include:
        1. Documentation of tasks personally performed (not tasks observed)
        2. Quantitative assessment of tasks personally performed within the past two years
        3. Qualitative assessment of tasks personally performed within the same timeframe
        4. Documentation of training in corrective measures and treatment in response to complications of tasks personally performed
    2. Maintenance of privileges for a non-physician anesthesia practitioner should be considered, requested, reviewed, and granted by the anesthesia service that is under the direction of a qualified doctor of medicine or osteopathy.5
      1. Requests for maintenance of privileges should include:
        1. Objective measures of task performance and outcomes
        2. Quantitative and qualitative assessment
        3. Peer review
        4. Risk management findings
    3. If a non-physician anesthesia practitioner has no formal training in a certain task, a structured training curriculum for the task should be completed, documented, and competency verified by the anesthesia service that is under the direction of a qualified doctor of medicine or osteopathy.10
      1. Competency verification should include the following elements to ensure patient safety:
        1. Demonstration of an understanding of the didactic education through an examination process or equivalent
        2. Documentation of task completion under physician supervision with an appropriate quantitative threshold to ensure competency
        3. Documentation of task completion under physician supervision with an appropriate qualitative assessment threshold to ensure competency

  1. American Society of Anesthesiologists. Statement on the Anesthesia Care Team. https://www.asahq.org/standards-and-guidelines/statement-on-the-anesthesia-care-team. Accessed June 2, 2023. 
  2. American Society of Anesthesiologists. Statement on the Anesthesia Care Team. https://www.asahq.org/standards-and-guidelines/statement-on-the-anesthesia-care-team. Accessed June 2, 2023.
  3. American Society of Anesthesiologists. Statement on the Anesthesia Care Team. https://www.asahq.org/standards-and-guidelines/statement-on-the-anesthesia-care-team. Accessed June 2, 2023.
  4. American Society of Anesthesiologists. Statement on Physician-Led Anesthesia Care. https://www.asahq.org/standards-and-guidelines/statement-on-physician-led-anesthesia-care. Accessed June 2, 2023.
  5. American Society of Anesthesiologists. Statement Comparing Certified Anesthesiologist Assistant and Certified Registered Nurse Anesthetist Education and Practice. https://www.asahq.org/standards-and-guidelines/statement-on-comparing-certified-anesthesiologist-assistant-and-certified-registered-nurse-anesthetist-education-and-practice. Accessed June 2, 2023.
  6. American Society of Anesthesiologists. Statement on Granting Privileges for Administration of Moderate Sedation to Practitioners. https://www.asahq.org/standards-and-guidelines/statement-on-granting-privileges-for-administration-of-moderate-sedation-to-practitioners-who-are-not-anesthesia-professionals. Accessed June 2, 2023.
  7. American Society of Anesthesiologists. Statement on Granting Privileges for Administration of Moderate Sedation to Practitioners. https://www.asahq.org/standards-and-guidelines/statement-on-granting-privileges-for-administration-of-moderate-sedation-to-practitioners-who-are-not-anesthesia-professionals. Accessed June 2, 2023.
  8. American Society of Anesthesiologists. Statement on Granting Privileges for Administration of Moderate Sedation to Practitioners. https://www.asahq.org/standards-and-guidelines/statement-on-granting-privileges-for-administration-of-moderate-sedation-to-practitioners-who-are-not-anesthesia-professionals. Accessed June 2, 2023.
  9. Centers for Medicare and Medicaid Services. 42 CFR § 482.52 Conditions of participation: Anesthesia services. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-482/subpart-D/section-482.52. Accessed June 2, 2023.
  10. Centers for Medicare and Medicaid Services. 42 CFR § 482.52 Conditions of participation: Anesthesia services. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-482/subpart-D/section-482.52. Accessed June 2, 2023.

 

Date of last update: October 19, 2023