A regional hospital is deciding whether to move to a 100% CRNA model in its anesthesia department. No physician anesthesiologists would be present in the hospital. The head CRNA will be supported by the regional director of anesthesia (an MD) at a hospital system in the next major city.

This hospital is in a state that allows CRNAs to practice independently and without the supervision of a physician. The CEO cited literature showing that the quality and outcomes of CRNA-led anesthesia is just as good as when physician anesthesiologists are involved in surgery. This move will also decrease costs for patients and the hospital.

Anesthesiologists complete courses relevant to practicing medicine, including laboratory courses and courses that give them comprehensive medical knowledge. They are expected to medically manage patient care and prevent or respond to complications and complex situations for patients receiving anesthesia, including intubation, both during surgery and in situations that might arise in the Emergency Department. Without a physician anesthesiologist in the OR, the only physician in the OR is the surgeon to manage any unexpected occurrences.

CRNA education and training prepares them to provide every type of anesthesia-related service and anesthetic drug, practice in every type of setting and participate in every type of procedure where anesthesia is required, and handle emergency situations. CRNAs are trained to work within the physician-led care team. CRNAs successfully complete a comprehensive didactic and clinical practice curriculum at a nurse anesthesia program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs

If you were an administrator at this hospital, what legal and safety patient benefits and liabilities would you want addressed by Legal, Risk Management, Quality, the Chief Medical Officer, and/or the Chief Nursing Officer?