No harm found when the scope of practice of nurse anesthetists is expanded to the whole process of anesthetic care and under indirect supervision of anesthesiologists: A time series study

Abstract

Background: More and more countries utilize nurse anesthetists as an anesthetic care provider to make up for the insufficiency of anesthesiologists.

Objective: To examine whether introducing nurse anesthetists with expanded scope of practice to anesthetic care would jeopardize the safety of patients and quality of anesthetic care.

Design: This observational study used an interrupted time series design.

Setting(s): A metropolitan teaching cancer hospital located in Southwest China.

Participants: 24290 patients with surgical procedures under general anesthesia from January 2015 to December 2017 were included.

Methods: In May 2016, nurse anesthetists with expanded scope of practice were introduced to anesthetic care. Administrative and medical record data were accessed to identify the occurrence of anesthetic outcomes including failed tracheal intubation and inability to ventilate with mask, aspiration, problem with airway in the post-anesthesia care room, hypothermia (temperature ≤ 35°C or chills), unplanned stay in the post-anesthesia care room longer than 3 hours, unexpected intensive care unit admission, reintubation, vascular and cardiopulmonary disorders and death. Statistical process control analysis was conducted to test special cause variation in outcomes over time.

Results: Findings demonstrated significant decrease in the proportion of patients staying in the post-anesthesia care room longer than 3 hours and with hypothermia following nurse anesthetists introduced to anesthetic care. Other anesthetic outcomes were not significantly changed.

Conclusions: The results demonstrate that involvement of nurse anesthetists with expanded scope of practice in anesthetic care did not jeopardize patients' safety or quality of anesthesia. Moreover, it may have beneficial impact in preventing prolonged stay in the post-anesthesia care room and hypothermia. Further research is required to examine the impact of involvement of nurse anesthetists in anesthetic care across all clinical contexts.

Keywords: Anesthetic team model; Nurse anesthetists; Patient outcomes; Quality of care.