Comparative effectiveness and safety of physician and nurse anaesthetists: a narrative systematic review †

Abstract

In view of the paucity of high-level primary evidence in this area, it is not possible to draw a conclusion regarding differences in patient safety as a function of provider type. There are difficulties in classifying events as "anaesthesia-related", and also in the variable definitions of "supervision" and "anaesthesia care team". We suggest that existing attempts to show differences in outcome might usefully be complemented by studies examining measures of anaesthetic process.

Anaesthesia underpins acute patient care in hospitals

“…4 The National Health Service (NHS) Modernisation Agency was born of multiple inquiries, the European Directive on Working Hours, and other demands. 5 Creation of the Postgraduate Medical Education Training Board is impacting on the role of the Royal College of Anaesthetists (RCA), 6 whose graduates are comparable to ANZCA graduates.…”

Anaesthetic practitioners in the UK: promise, perils and psychology

“…Our interpretation of these studies was that there was no consistent high level evidence for a difference in safety between physician and non-physician anaesthetists [7]. Furthermore, it is extremely unlikely that any such evidence would ever be generated.…”

“…We found only four reports of primary research addressing the question of whether there was a difference in safety or effectiveness between physician and non-physician anaesthetists [7]. None of these was a randomised comparison, and all had methodological flaws.…”

Methodological Issues in Explaining Maternal Outcomes

“…Although there are a number of published studies on this issue (Abenstein & Warner, 1996;Silber et al, 2000), the results are subjects of continued discussion because of design limitations (Fleisher & Anderson, 2002;Smith, Kane, & Milne, 2004). Resolution of these design issues will improve the soundness of the findings generated by this area of health services research.…”

“…This study explores two limitations. Smith et al (2004), based on their extensive literature review, concluded that because of the lack of high-level primary evidence it is not currently possible to draw conclusions regarding whether there are differences in outcomes that are a function of anesthesia provider type. They described anesthesia provider characterization as one challenge to achieving this high-level evidence.…”