No harm found when nurse anesthetists work without supervision by physicians.

Area of Science:

• Healthcare Policy
• Anesthesiology
• Nursing Practice

Background:

• Centers for Medicare and Medicaid Services (CMS) introduced an opt-out option for state-level supervision of nurse anesthetists in 2001.
• By 2005, fourteen states had adopted this policy, allowing for independent practice by certified registered nurse anesthetists.

Purpose of the Study:

• To evaluate the impact of state opt-out policies on patient safety and outcomes.
• To determine if removing surgeon or anesthesiologist oversight for nurse anesthetists affects inpatient mortality or complication rates.

Main Methods:

• Analysis of Medicare data spanning from 1999 to 2005.
• Comparison of patient outcomes in states that opted out versus those that maintained supervision requirements.

Main Results:

• No statistically significant increase in inpatient deaths was observed in states that allowed nurse anesthetists to practice without surgeon or anesthesiologist supervision.
• Similarly, no evidence of increased patient complications was found following the implementation of opt-out policies.

Conclusions:

• The findings support the safety of allowing certified registered nurse anesthetists to practice independently.
• Recommendations are made for CMS to permit nurse anesthetist autonomy in all states, removing the mandatory supervision requirement.