Which "Standard of Care" Does One Follow ?

When it comes to determining the "Standard of Care" for anesthesia providers, the two dominant professional organizations that represent approximately 80,000 anesthesia providers, the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA), have decidedly different viewpoints.

The July 2010 LawMed Blog describes the dilemma: 

"...The basic issues regarding monitoring, procedures and various technical aspects of the delivery of anesthesia are much agreed upon when it comes to a “standard” within the community of anesthesia providers. Fiercely disputed however, is who should practice that standard and when. No where else in medicine does state law determine a standard of care more than in the practice of anesthesia. And nowhere else in medicine is state law ignored as much as possible in a fight aimed at creating separate standards of care for the same health care..." . 

Anesthesia practice models described by LawMed:

"...There are two independent providers of anesthesia in the United States: Certified Registered Nurse Anesthetists (CRNA) and physician Anesthesiologists (MDA). CRNAs may practice independent of a MDA in all 50 states and are trained to administer all manner of anesthetics including general, spinal, epidural and various peripheral nerve blocks, for all manner of surgeries including pediatrics, open heart, organ transplantation, etc. The majority of rural hospitals are serviced by CRNAs alone. In most larger hospitals and academic medical centers CRNAs and MDAs work side by side under the ASA Anesthesia Care Team (ACT) model, with the MDA supervising the care provided by the CRNAs often at a ratio of up to 1:4. No state laws dictate that the ACT approach is to be employed. The AANA has their own version of CRNAs and MDAs working together.  Often a variation of the ACT  is used where very little supervision is involved and collaboration is a better term. In still other variants MDAs and CRNAs work side by side but as equal colleagues with none supervising the other. And finally there are MDAs who work alone...".

And the LawMed conclusion:

"...There are countless examples of such discrepancies between the two associations ‘standards’, ‘guidelines’ and ‘recommendations’ including administration of spinal and epidural anesthesia, use of the anesthesia care team approach, provision of anesthesia in the office setting, pain management, organization of an anesthesia department, pre-operative patient evaluation and on and on. One of the safest specialties in nursing and medicine has the most contentious diametrically opposed view of how the specialty should be practiced. All the evidence regarding quality of care and outcomes indicates that there should be no disagreement at all."

We plan to continue to follow and comment on the anesthesia standard of care dilemma and have found the LawMed blog an excellent resource for those seeking an understanding and perhaps clarification on the medical legal perspective of anesthesia standards.