Efficient anesthesia staffing is a win-win for patients and facilities

The financial side of the healthcare industry continues to be a hot topic for consumers and healthcare administrators alike. Rising costs, facility closings especially in rural areas, and the needs of an aging population dominate the headlines at healthcare institutions.

Balancing patient care with cost-effectiveness can be a difficult and delicate position for healthcare administrators, who often need to make tough choices. The key is evaluating the facility as a whole — all of its services, departments and staff — and making those pieces fit in the most worthwhile way. An often-elusive goal is arriving at a staffing model that balances patient care with cost, so the facility is functioning at maximum efficiency while providing high quality care.

One vital piece of this puzzle is anesthesia. Developed by the American Association of Nurse Anesthesiology (AANA), the Efficiency-driven Anesthesia Model (EDAM) approaches anesthesia staffing in such a way that makes the most of limited resources while ensuring high quality and access to care. EDAM:

• Organizes variables unique to a healthcare facility or system while assessing requirements for best practices.
• Limits duplication of services, improves effectiveness, increases access and reduces costs.
• Reevaluates current anesthesia models to improve safe practice, cost effectiveness and accessibility.

EDAM is about increasing the involvement of Certified Registered Nurse Anesthetists (CRNAs), also known as nurse anesthesiologists or nurse anesthetists. Maximizing the use of CRNAs helps facilities increase efficiency while reducing unnecessary healthcare spending. Studies show that increasing CRNA involvement and reducing restrictions on CRNA-provided services results in care as safe and equitable as that delivered by physician anesthesiologists or in more restrictive anesthesia staffing models.

"This is about engaging both CRNAs and physician anesthesiologists to practice at the full extent of their education, licensure, and scope of practice, while offering healthcare systems the flexibility to align with local needs and financial constraints," says AANA President Janet Setnor, MSN, CRNA, Col. (Ret), USAFR, NC. "The time has come to ask questions and listen to communities to select the best Efficiency-driven Anesthesia Model that meets the needs of any given location."

There are three anesthesia staffing models for facilities to consider:

Consultative/Collaborative model. This is designed to promote professional cooperation and to create the most value for patients. In this model, all anesthesia providers are clinically autonomous and encouraged to use their full skill set and licensure in caring for patients.

Anesthesia Care Team model. This requires heavy physician anesthesiologist involvement in key portions of every procedure, as well as fulfilling federal Medicare billing and reimbursement requirements under the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982. These two matters contribute to increased healthcare costs by mandating a maximum 1:4 ratio of physician anesthesiologists to CRNAs.

Independent CRNA or Physician Anesthesiologist model. This model sees a single anesthesia provider who either works on their own or as part of a team made up of only CRNAs or physicians. It has traditionally been employed by lower-volume facilities in rural areas, but now it's being used more often in non-hospital-based settings like ambulatory surgical centers or medical offices.

The AANA's President Setnor says Efficiency-driven Anesthesia Modeling is a win-win for healthcare facilities and patients alike by identifying the most appropriate anesthesia care delivery system for any given location. By making efficient anesthesia provider staffing a facility's central goal, it helps make the most of its limited resources, she notes.

CRNAs currently provide the majority of anesthesia services in rural facilities. CRNAs are ready to provide effective, more efficient and equitable anesthesia care to many facilities, including those struggling to attract high-cost physician anesthesiologists.

For more information, or to download key resources for Efficiency-driven Anesthesia Modeling, visit AnesthesiaFacts.com or contact the American Association of Nurse Anesthesiology.