Anesthesia staffing models are a chief concern of many hospital executives, leading to a number of questions about how to best ensure maximum efficiency of the operating room. For example:
How many hospital anesthesia clinicians does my facility need to employ?
What is the most appropriate clinician mix of MDs and CRNAs that fosters cost-effective, high-quality care?
Is a care team model suitable for my hospital?
Perhaps the biggest question, or at least the one that has generated much discussion in the industry, is the supervision ratios of MDs to CRNAs. In recent years, as hospitals have searched for the most effective way to deliver anesthesia services, the supervision ratio has frequently been adjusted. Some contend that by extending the ratio of one MD supervising more CRNAs, quality of patient care may diminish.
A recent study published in the March issue of Anesthesiology supports that notion, but also shows that lapses in supervision occur most frequently during first-start cases because of concurrent times of critical care even if the ratio is 1 MD to 2 CRNAs. Simply, if two cases started around 8am, the anesthesiologist may not be able to monitor both patients during critical portions of the case, which occur right around the same time.
Researchers concluded that staggered starts or more MDs on staff at the start of the day would reduce the likelihood of supervision lapses.
Robert Goldstein, MD, Somnia Anesthesia’s chief medical officer, understands the recommendation of staggering start times, but believes it may not be the ultimate solution.
“Staggered morning starts are an interesting suggestion but may run counter to patient and surgeon wishes and could ultimately be more costly the facility,” says Dr. Goldstein. “Similarly, changing staffing ratios is probably not cost effective and patient safety is no more guaranteed. The ideal use of a care team model would allow Anesthesiologists and CRNAs more flexibility (then currently afforded by the CMS rules of medical direction) to allocate professional resources according to the case intensity, patient physical status and the competency of the clinicians assigned.”