Has Successfully Reduced Anesthesia Mortality Rates From Two Deaths Per 10,000 Anesthetics Administered To One Death Per 200,000-300,000

At this point, it is not necessary nor helpful to the healthcare marketplace for Congress to intervene by requiring yet another study about the quality of care that CRNAs provide. There is no question about the safety or quality of care that is provided by CRNAs. A published article on malpractice data from the National Practitioners Data Bank (NPDB) reveals that from 1990 through 1997, anesthesia-related malpractice claims against physicians outnumber claims against nurses by nearly 7 to 1. Think about that - 700% more physician anesthesia malpractice codes than nurses. While AANA did not elevate this issue into a question of patient safety, the ASA's relentless attacks on our safety force us to advise Congress that the anesthesiologists have problems of their own. CRNAs safely provide over 65% of the nation's anesthesia. According to the recently released Institute of Medicine report titled "To Err is Human," anesthesia delivery provides a model for advancement in the safe delivery of health care: "Anesthesiology has successfully reduced anesthesia mortality rates from two deaths per 10,000 anesthetics administered to one death per 200,000-300,000 anesthetics administered." In fact, the Institute of Medicine cites the improvements in anesthesiology numerous times throughout the report. What is interesting is the factors cited include: improved monitoring techniques, the development and widespread adoption of practice guidelines, and other systematic approaches (p. 27); or, technological changes, information-based strategies, application of human factors to improve performance, such as the use of simulators for training, formation of the Anesthesia Patient Safety Foundation, and having a leader who could serve as a champion for the cause. Nowhere in the IOM report is the astounding increase in anesthesia safety attributed to anesthesiologist supervision of nurse anesthetists. If CRNAs were such a danger to patients, surely the IOM would have cited such a danger in this preeminent report on patient safety. Yet, the IOM only touts how the profession of anesthesia has dramatically improved patient safety. We believe the IOM report speaks volumes about the profession of nurse anesthesia and the quality of care we provide. We have evidence that senior citizens feel the same way. A nationwide survey of Medicare patients conducted in October, 1999 by Wirthlin Worldwide reveals that 88 percent of Medicare patients would be comfortable if their surgeon chose a nurse anesthetist to provide their anesthesia. Nearly two-thirds of the respondents indicated it would be acceptable for the nurse anesthetist to not be supervised by their surgeon, but work collaboratively with the surgeon who is always present throughout the operation. When supervision is eliminated, CRNAs will continue to work with a physician, usually the surgeon, in a collaborative relationship, and will remain with their patients from the beginning to the end of their procedures. Compared to nurse anesthetists, many anesthesiologists rarely provide hands-on patient care, and even fewer remain with their patient throughout the surgical procedure (when anesthesia is given through the care team in which both nurse anesthetist and anesthesiologist participates). In fact, we would like to bring to your attention questions about the adequacy of the preparation of anesthesiologists, as raised within their own profession. The anesthesiologists have systematically sought to discredit CRNAs as not having enough education. However, you should take note of the comments recently printed in their own Newsletter. Dr. Michael Ryan, M.D. in his article, "Anesthesiology's Workforce: The Good, the Bad, and the Ugly - A Resident's Perspective" (American Society of Anesthesiologists Newsletter, April, 2000, Vol. 64, Number 4, pp. 17-18) said, in part: