CRNAs are the solution to delayed surgical care for veterans

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(BPT) - As we honor veterans this month, it can be easy to forget about the challenges some continue to face at home: challenges that include undergoing critical medical procedures in a timely manner.

Long wait times

Veterans have to wait too long for surgical care in U.S. Department of Veterans Affairs (VA) facilities. According to a survey by Veterans Need Care Now, a grassroots coalition committed to reducing surgical wait times, 23% of veteran households report delays in securing VA health appointments and surgical procedures.

Access to high-quality, timely care

Veterans deserve access to high-quality care without long wait times. Reports have shown a lack of access to anesthesia services in the VA, which may be a contributing factor to lengthy wait times along with other factors such as staff shortages, limited space and access to specialists. A national review of staffing shortages at the Veterans Health Administration (VHA) for fiscal year 2021 found anesthesiology shortages at numerous VHA facilities, including in Massachusetts, Rhode Island, New York, Pennsylvania, North Carolina, Florida, Tennessee, Michigan, Indiana, Illinois, Louisiana, Arkansas, Colorado, Oklahoma, Washington State, California, and Minnesota.

Two types of medical professionals are able to deliver anesthesia to patients: physician anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs).

The ability of CRNAs to provide high-quality care, even under the most difficult circumstances, has been recognized by every branch of the U.S. military. CRNAs have full practice authority in the Army, Navy, and Air Force and are the predominant provider of anesthesia on forward surgical teams and in combat support hospitals, where 90% of forward surgical teams are staffed by CRNAs. “The high quality of care that CRNAs can be trusted to provide is reflected in our military, where CRNAs are allowed to practice independent of physician referral and supervision,” said AANA President Angela R. Mund, DNP, CRNA.

While CRNAs care for wounded soldiers on battlefields, and they safely and cost effectively provide quality anesthesia care to veterans here at home, many VA hospitals only allow CRNAs to provide anesthesia under the supervision of a physician anesthesiologist. Requiring an additional person for the procedure can create a backlog of access to critical procedures as well as added expenses. This federal mandate creates an unnecessary barrier to expanding care and exacerbates any provider shortages.

Finding a solution and shortening wait times

Results of a study by RTI International indicated that allowing nurse anesthetists to provide anesthesia services without supervision from a physician does not put patients at increased risk. In fact, no significant difference was found in patient outcomes when comparing the three scenarios studied: CRNAs working alone in the operating room without anesthesiologist supervision, anesthesiologists working alone, and the CRNA and anesthesiologist working together on a case.

During the COVID-19 pandemic the federal government suspended the supervision requirement for CRNAs so more patients could have access to the care they needed. And now, 22 states have opted out of the federal Medicare requirement that calls for physician supervision of CRNAs.

A study by the Lewin Group shows that a CRNA practicing without supervision is the most cost-effective method of anesthesia delivery and that increasing the number of CRNAs and permitting them to practice in the most efficient delivery models will be key to containing costs while maintaining quality care. Based on this evidence, CRNA full practice authority within the VA can increase veteran access to care, lower wait times, and decrease costs.

To learn more about the role and duties of CRNAs, visit VeteransNeedCareNow.org.

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