Impact of reduced restrictions in scope of practice of nurse anesthetists on patient safety across states

Background Before the COVID-19 pandemic, some states granted certified registered nurse anesthetists (CRNAs) full practice rights (no supervision), other states required direction/collaboration under a physician, and yet others required physician supervision. However, during the pandemic, the growing healthcare needs and simultaneous shortage of healthcare providers prompted major shifts in the delivery of healthcare services via efforts at both the federal and state levels. Purpose To examine the impact of the pandemic-related reduced restrictions in scope of practice, specifically allowing CRNAs to practice to the full extent of their education and training, on anesthesia-related complications rates. Methods Using administrative claims data from Optum's de-identified Normative Health Information between January 1, 2018, and December 31, 2022, and a difference-in-differences model, we examined the association between reduced restrictions in state scope of practice and anesthesia-related complications, controlling for procedure, patient, and geographic-level characteristics. Results During the pandemic, there was a statistically significant ( p = 0.0006) reduction of 0.02 percentage points in anesthesia complications (two anesthesia complications per 10,000 anesthesia procedures) in states that allowed pandemic-related reduced restrictions in state scope of practice compared to states with no change in scope of practice. Conclusion Reduced restrictions in state scope of practice during the pandemic were not associated with any increase in anesthesia-related complications. These findings add to existing evidence on the safety of anesthesia procedures performed by CRNAs and expand the evidence to include safe procedures during the pandemic. Our findings inform strategic planning and public policy to support teamwork and reform the healthcare system to prepare prudently for future healthcare emergencies.