US Air Force Grants CRNAs Independent Practice at Their Facilities




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In an effort to improve patient safety while providing the most-cost effective anesthesia care, the U.S. Air Force has instituted a new policy that allows Certified Registered Nurse Anesthetists (CRNAs) to perform independently based on their scope of practice.

The landmark studies that supported the utilization of CRNAs in patient care – an Institute of Medicine report in 2010, “The Future of Nursing: Leading Change, Advancing Health,” and a 2010 Health Affairs study titled “No Harm Found when Nurse Anesthetists Work Without Supervision by Physicians” – were valuable resources that assisted the Air Force Medical Service (AFMS) in their decision.

This new guideline follows protocols set forth by other American military service branches as well as 16 states that currently have exemption from federal regulation of physician supervision of CRNAs.

While the new rule change enables CRNAs to administer anesthesia services without medical direction from an anesthesiologist, the anesthesia care team (ACT) model is highlighted as the preferred practice model of the AFMS, citing studies that show a reduction in mortality and morbidity rates when an ACT model is utilized.

In the traditional sense, ACT refers to a CRNA performing duties under medical supervision, but the AFMS will allow any combination of anesthesiologist or CRNAs working collaboratively.

Another wrinkle of the updated policy is that directors of Air Force treatment facilities can appoint an MD or CRNA as chief of anesthesia as long as the clinician is the most experienced and competent provider in a medical treatment facility (MTF). However, in an MTF with three or more operating rooms, the assigned chief will most likely be a board-certified anesthesiologist.

“It’s nice to see the Air Force recognize the excellent capabilities of CRNAs and allow these clinicians to practice within a model that emphasizes their skill set and experience,” said Robert C. Goldstein, MD, Somnia’s Executive Vice President and Chief Medical Officer. “As highlighted in our latest white paper, the inclusion of CRNAs in a care team model carries enormous benefits for facilities, clinicians, and patients.”

Somnia Anesthesia

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