To meet the growing demands of anesthesia practices, there are currently four possible types of anesthesia administration teams, consisting of various arrangements of anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), and other anesthesia care practitioners. These are the all-physician model, the all-CRNA model, the physician/CRNA model, and the anesthesia care team model. The anesthesia care team model, made up of any combination of non-physician anesthesia providers performing under the guidance of a qualified anesthesiologist, creates a highly supervised and organized environment in a busy surgical facility.
Under the care team model, the anesthesiologist retains virtually all responsibility for a patient, but may delegate tasks to other providers to increase efficiency and improve care. These other team members may include CRNAs, anesthesiologist assistants (AAs), and CRNA or AA students. Anesthesiology fellows or residents may also be part of the care team, operating under the supervision of the lead anesthesiologist.
While the make-up of the team may resemble that of the physician/CRNA model, the responsibilities and specific roles of individuals differ significantly. Although CRNAs who are members of the care team may administer the anesthetic themselves, the anesthesiologist is responsible for prescribing a safe and high quality anesthetic plan and discussing it with the patient. Depending on the procedure and patient’s medical condition, the anesthesiologist may delegate certain anesthetic monitoring tasks to other members of the team, while remaining available for intervention in emergency situations. Non-physician personnel also contribute to collection and documentation of patient data in pre and post-operative evaluations, however the anesthesiologist makes the final decisions regarding the patient’s treatment plan or progress. Through this model, routine post-operative care is usually delegated to post-anesthesia nurses. More detailed information on the organization of the care team, as well as policies set forth by the American Society of Anesthesiologists (ASA) can be found on the ASA website.
The anesthesia care team model has been implemented by many hospitals to increase efficiency and cut down costs. It is less expensive than the all-physician approach and allows anesthesiologists to be available for patient evaluations, consultations, and other essential aspects of patient care. Of course, conflicts may sometimes arise, specifically in determining the roles and responsibilities of anesthesiologists and non-physician practitioners working in the same environment. A study conducted in 2009 by Terri S. Jones et al. found that the main causes of conflict between professionals operating under the care team model were a lack of clarity in role expectations as well as a narrow scope of practice for non-physician providers.
Nevertheless, the anesthesia care team model, with its many benefits, remains highly utilized among surgical centers in the U.S. As detailed in a statement from the American Academy of Anesthesiologist Assistants (AAAA), such a system allows all personnel to work together to focus on providing the highest quality of anesthesia care to patients and in ensuring their safety. Furthermore, as noted in the Jones et al. study, collaboration between anesthesiologists and other anesthesia care providers is maximized through this model, often leading to higher patient satisfaction and an increased number of positive surgical outcomes.
References:
“ASA Statement on the Anesthesia Care Team”: https://www.asahq.org/advocacy/state-activities/core-issues/anesthesiologist-assistants
http://www.beckersasc.com/anesthesia/ins-and-outs-of-4-asc-anesthesia-provider-models.html
https://www.asahq.org/lifeline/who%20is%20an%20anesthesiologist/anesthesia%20care%20team
https://www.aana.com/newsandjournal/Documents/crnacollaboration_1209_p431-436.pdf
https://aaaa.memberclicks.net/assets/docs/position%20statement%20-%20anesthesia%20care%20team.pdf
http://www.aana.com/advocacy/stategovernmentaffairs/Pages/Fact-Sheet-Concerning-State-Opt-Outs.aspx
