New edition of Miller bashes CRNAs

lapappey · Apr 10, 2005

Well, without seeing it, I'm not sure that quoting from a research study qualifies as "bashing."

I know that there is research out there that says that CRNAs are just as safe as MDs and also that CRNAs tend to have better pt satisfaction ... what exactly is the study that they are referring to? I assume that it says that CRNAs aren't as safe as MD's. Is the other research just ignored? Or what?

gotosleep · Apr 10, 2005

Well, without seeing it, I'm not sure that quoting from a research study qualifies as "bashing."
I know that there is research out there that says that CRNAs are just as safe as MDs and also that CRNAs tend to have better pt satisfaction ... what exactly is the study that they are referring to? I assume that it says that CRNAs aren't as safe as MD's. Is the other research just ignored? Or what?

Statements like the following are what I am alluding to. Please note the last sentence in this excerpt.

"The Stanford Center for Health Care Research[198] also evaluated the impact of provider on outcome of care. They prospectively collected data from 8593 patients undergoing 15 surgical procedures over a 10-month period (May 1973 through February 1974). Using a risk-adjustment methodology, the actual patient outcome was compared with that predicted by the patient's health status and operative procedure. The investigators reported that death plus severe morbidity was 11% higher than predicted for patients who received their care in a nurse anesthetist-only setting, 3% lower than predicted for physician-only care, and 20% lower than predicted for an anesthesia care team environment. Because of the small sample size, these findings did not reach statistical significance between the groups.

"

Now this coupled with the fact that they do not address other studies that directly refute the results of this study are what I consider intellectually lazy at best. For example:

[Pine, M, Holt, KD, Lou, YB. "Surgical Mortality and Type of Anesthesia Provider." AANA Journal. 2003; 71:109-116.]

400, 000 sample size vs. the 8593 sample size of the previously mentioned study.

Perhaps bashing may not be the best word for this, but this certainly is not worthy of being in the textbook that is considered the gold standard for anesthesia care. This smells of political hackery and deliberate misinformation.

Sheri257 · Apr 10, 2005

They prospectively collected data from 8593 patients undergoing 15 surgical procedures over a 10-month period (May 1973 through February 1974).

Interesting that the data is also over 30 years old.

:coollook:

JimmyMallo · Apr 10, 2005

It is also interesting to note that this does not specify death or morbidity that is anesthesia related. Since many CRNA only hospitals are in rural areas with less technology and resources, it would be interesting to look at overall patient outcomes for rural vs. urban hospitals in general before using the data to make a statement on CRNA's. With that in mind, many hospitals that use a "team" approach are large teaching facilities with the latest training and technology. This study seems to draw conclusions that are not warranted with a questionable methodology and a very small sample size. The fact that they put a disclaimer at the end of the statement begs the question why in the hell did the writer think it was worth printing?

Nurse Ratched, RN · Apr 10, 2005

Wow, I can totally understand you being honked at that. Intellectually lazy, indeed. Perhaps they had to go to a tiny sample size 30+ years old to find data that supported their preconceived notion?

I see a flood of angy letters, and rightfully so.

Where's Kevin McHiugh?

gaspassah · Apr 11, 2005

although i agree that it's somewhat disheartening to see the editors of miller put those things in print, what i dont understand is why anyone is suprised. ologist will always find a way to rib, putdown, and otherwise belittle the role of the nurse anesthetist. rarely are you going to find an ologist that supports crna's, for one, it's against their stance that anesth is medicine, 2 we are a threat to their livelihood. independant crna practice is safe, cost effective and we provide a quality service. that in itself is a threat to ologists. what we can do is to continue to educate the public that what we do is safe quality anesthesia that is patient focused, provide the surgical teams with attentive quality service, and continue to show medical facilities our cost effective side. we must stand our ground and make headway in the political arena. if we continue to graduate the best nursing has to offer, continue to support our educational fields with quality instructors and continue to support our national organization we will continue to expand our areas of expertise and practice arenas. if we settle for the status quo, lower our standards to increase graduation rates and give ground to the a$a, we will ultimately fall prey to the animal that is medically directed anesthesia. you MUST support our national organization with time and money, they fight our fights with AND for us.

just my .02

deepz · Apr 11, 2005

...... independant crna practice is safe, cost effective and we provide a quality service. that in itself is a threat to ologists. what we can do is to continue to educate the public .......

http://www.gaspasser.com/

!

loisane · Apr 11, 2005

As you can see, this issue is well known to the experienced CRNA community. For the CRNA rebuttal to this research spin, see the AANA website at http://www.aana.com/crna/prof/quality.asp

There are methodlogical flaws in many of these studies. Reportedly, some were turned down for publication several times before finally appearing in the journal sponsored by ASA.

The bottom line here applies to all research evaluation. Just because a study makes a conclusion, and it gets published, does not establish truth. Everything must be examined with all of our critical thinking skills. (And of course, that also applies to "our" studies, published in "our" journal. )This part of the scientific process often gets forgotten, especially among the public and media.

Sigh, yes it is a shame such a respected text would include such bias. But as others have said, it really isn't too surprising. I agree with the OP that it is something to think about in making a purchase decision, and there are other fine texts available.

loisane crna