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May 1, 1989Medical Care

When Do Anesthesiologists Delegate?

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Why the study?

What factors influence the decision of anesthesiologists to delegate to nurse anesthetists (CRNAs) versus practicing alone?

Population

Data from the 1986 Anesthesia Practice Survey regarding anesthesia services and providers

Comparison

Team approach vs Solo anesthesiologist arrangement

Design

Cross-sectional

Authors

MRMargo RosenbachNational Center for Health ResearchJCJerry CromwellRTI International

Discussion

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Implication

Observed supply and case factors associate with team anesthesia; leaves open whether incentives can promote cost-effective delegation.

Key Points

  • To identify the clinical, organizational, and regional factors determining when anesthesiologists choose a team-based delegation model with nurse anesthetists over solo practice.
  • Conducted a logistic regression analysis utilizing cross-sectional data from the 1986 Anesthesia Practice Survey.
  • Team-based delegation was significantly more likely in regions with a greater local supply of certified registered nurse anesthetists (CRNAs), in teaching and public facilities, in high-volume surgical hospitals, during emergency or lengthy procedures, during less complex surgeries, and for patients with poorer preoperative physical status.
  • Solo anesthesiologist practice was significantly more common outside of New England and in geographic areas with higher densities of anesthesiologists, where the probability of CRNA utilization declined.

Structured PICO

What factors influence the decision of anesthesiologists to delegate to nurse anesthetists (CRNAs) versus practicing alone?

P
Population
Data from the 1986 Anesthesia Practice Survey regarding anesthesia services and providers
I
Intervention
Team approach (delegation to nurse anesthetists/CRNAs)
C
Comparator
Solo anesthesiologist arrangement
O
Outcome
Factors associated with the delegation of anesthesia services to CRNAs

Delegation to CRNAs is influenced by provider supply, hospital characteristics, and case complexity, suggesting that financial incentives could be used to encourage cost-effective team-based anesthesia care.

Cite This Study

Rosenbach et al. (1989) studied this question.

synapsesocial.com/papers/6a984b243b468e51b023cf4ehttps://doi.org/10.1097/00005650-198905000-00002
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A STUDY OF THE DEATHS ASSOCIATED WITH ANESTHESIA AND SURGERY1954 · 771 citations
  2. 2The Baltimore Anesthesia Study Committee1960 · 61 citations
  3. 3The Role of Anesthesia in Surgical Mortality1961 · 1,046 citations
  4. 4Characteristics of Nurse Anesthetists Working With and Without Anesthesiologists1987 · 5 citations