An Overview of the Anesthesiologist Assistant What the

An Overview of the Anesthesiologist Assistant: What the CRNA Should Know Heather Baglio, RN, BSN, SRNA Jessica Hammond, RN, BSN, SRNA

Objectives • Explain the historical development of the Anesthesiologist Assistant (AA) profession • Define the scope and standards of practice for AAs • Discuss specific legalities of the AAs practice • Discuss the AAs educational background, curricula, program accreditation, certification and continuing education • Differentiate the role of the CRNA and AA in the healthcare setting.

History Joachim S. Gravenstein John E. Steinhaus Perry P. Volpitto

Facts and Figures WHO ARE THEY? ? HOW MANY ARE THERE? ?

By the Numbers… In the Workforce Anesthesiologist and Residents CRNA AA

ACT Model Anesthesiologist Resident Physician CRNA AA

Educational Background

Admission Requirements • Bachelor’s degree • Science and math pre-requisites • MCAT/GRE • Clinical shadowing experience (8 hrs) • Personal Interview

Program of Study • Master’s Degree Programs • 24 -28 months • 56 -132 didactic hours • Clinical hour requirements 2000 -2500 hours • Minimum of 600 cases (avg ~ 800) • All sub- specialties of anesthesia

CRNA vs. AA Education

Accreditation and Certification

Governing Entities/Professional Organizations

Scope

Supervision Legalities Prescriptive Authority Anesthesiologist to AA Ratio

Location of Practice

Supervision and Practice Jurisdiction CRNA AA

Patient Safety: What the Literature Says… Evidence Supporting AAs Evidence Supporting CRNAs • University Hospital Quality Assurance • Kentucky Legislative Research Commission • Dulisse & Cromwell (2010) • Needleman & Minnick (2009) • Pine, Holt & Lou (2003) • Simonson, Ahern & Hendryx (2007)

“Opinions have caused more ills than the plague or earthquakes on this little globe of ours. ” -Voltaire

The Future

References • • • • • The American Academy of Anesthesiologist Assistants. (2012). Retrieved from http: //www. anesthetist. org American Academy of Anesthesiologist Assistants. (2006, March 31). Statement on the anesthesia care team model. Retrieved from http: //www. anesthetist. org/practicestatements/ACT_Position_Statement. pdf American Academy of Anesthesiologist Assistants. (n. d. ) AAAA statement on clinical doctorate degrees. Retrieved from http: //www. anesthetist. org/practicestatements/Statement_on_Clinical_Doctorate_Degrees. pdf American Academy of Anesthesiologist Assistants. (2011, February). Comparison of AAs and CRNAs education and practice. Retrieved from http: //www. anesthetist. org/lobby/Comparison_of_AAs_and_CRNAs_Education. pdf American Association of Nurse Anesthetists (2012). Anesthesia assistant tool kit. Retrieved from http: //www. aana. com Berry, A. J. , Odom, S. H. (2003). Assuring competency of anesthesiologist assistants: Education program accreditation and graduate certification. ASA Newsletter, 67(3), 9 -10. Retrieved from http: //www. asahq. org/For. Members/Publications-and-Research/Periodicals/ASA-Newsletter. aspx? year=2012&ypp=5 Case Western Reserve University. (2010). Anesthesia program: Program overview. Retrieved from http: //casemed. case. edu/anesthesiaprogram/ Commission on Accreditation of Allied Health Education Programs. (n. d. ) Anesthesiologist assistant. Retrieved from http: //www. caahep. org/Content. aspx? ID=2 Commission on Accreditation of Allied Health Education Programs. (2004). Standards and guidelines for the accreditation of educational programs in anesthesiologist assistant. Retrieved from http: //www. anesthesiaprogram. com/pdfs/AA_Standards. pdf Daugherty, L. , Fonseca R. , Kumar, K. B. , Michaud, P. (2010). An analysis of the labor markets for anesthesiology. Santa Monica, CA: RAND Corporation. Retrieved from http: //www. rand. org Dulisse, B. , & Cromwell, J. (2010). No harm found when nurse anesthetists work without supervision by physicians. Health Affairs, 29(8), 1469 -1475. doi: 10. 1377/hlthaff. 2008. 0966 Emory University. (2013). Master of science program in anesthesiology. Retrieved from http: //med. emory. edu/aa_program/ Georgia Association of Nurse Anesthetists. (2012). Fact sheet about AAs. Retrieved from http: //www. gana. org Gravenstein, J. S. , Steinhaus, J. E. , & Volpitto, P. P. (1970). Analysis of manpower in anesthesiology. Anesthesiology, 33(3), 350 -357. Gunn, I. P. (2000). Rural health care and the nurse anesthetist. CRNA, 11(2), 77 -86. doi: 10. 1053/CRNA. 2000. 8004 Institute of Medicine. (2011, June). Relieving pain in America: A blueprint for transforming prevention, care, education, and research (Report Brief). Retrieved from http: //www. iom. edu/Reports/2011/Relieving-Pain-in. America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research/Report-Brief. aspx

References • • • • Legislative Research Commission. (2007, February). A study of anesthesiologist assistants (Research Report No. 337). Retrieved from https: //www. asahq. org/For-Members/Advocacy/State-Legislative-and-Regulatory. Issues/~/media/For%20 Members/Advocacy/State%20 Issues/AA%20 Study%20 Report%20337. ashx Mackey, D. C. (2003). Anesthesiologist assistants: A new direction for the anesthesia care team begins to accelerate (finally!). ASA Newsletter, 67(3), 4. Retrieved from http: //www. asahq. org/For-Members/Publicationsand-Research/Periodicals/ASA-Newsletter. aspx? year=2012&ypp=5 Nagelhout, J. J. & Zaglaniczny, K. L. (Eds. ). (2009). Nurse Anesthesia (4 th Ed. ). Philadelphia: Saunders. National Commission for Certification of Anesthesiologist Assistant. (n. d. ). National Commission for Certification of Anesthesiologist Assistant. Retrieved from http: //www. aa-nccaa. org Needleman, J. , Minnick, A. F. (2009). Anesthesia provider model, hospital resources, and maternal outcomes. Health Services Research, 44(2), 464 -482. doi: 10. 1111/j. 1475 -6773. 2008. 00919. x Nova Southeastern University. (n. d. ) Anesthesiologist assistant: Program overview. Retrieved from http: //www. nova. edu/chcs/healthsciences/anesthesia/fort_lauderdale/index. html Pine, M. , Holt, K. D. , Lou, Y. B. (2003). Surgical mortality and type of anesthesia provider. AANA Journal, 71(2), 109116. Retrieved from http: //ezproxy. ycp. edu: 8000/login? url=http: //search. ebscohost. com/login. aspx? direct=true&db=rzh&AN=200308 4684&site=ehost-live&scope=site Plagenhoef, J. S. (2008). Anesthesiologist assistants vs. nurse anesthetists…what are the differences? ASA Newsletter, 72(2), 18 -20. Retrieved from http: //www. asahq. org/For-Members/Publications-and. Research/Periodicals/ASA-Newsletter. aspx? year=2012&ypp=5 Simonson, D. C. , Ahern, M. M. , Hendryx, M. S. (2007). Anesthesia staffing and anesthetic complications during cesarean delivery. Nursing Research, 56(1), 9 -17. Retrieved from http: //ovidsp. tx. ovid. com. ezproxy. ycp. edu: 8000/sp 3. 7. 1 b/ovidweb. cgi? &S=LNINFPGLJEDDLFKANCPKIDFBNPMKAA 00&Link+Set=S. sh. 18. 19. 23. 27%7 c 1%7 csl_10 South University. (2013). Anesthesiologist assistant program. Retrieved from http: //www. southuniversity. edu/nursing-and-health-professions-programs/anesthesiologist-assistantprograms/history. aspx University of Missouri- Kansas City (n. d. ) Master of science in anesthesia program. Retrieved from http: //www. med. umkc. edu/MSA/ Stafford, D. J. (2002, August, 1). AA Issue Heats up in Louisiana. Nurse. Retrieved from http: //news. nurse. com/apps/pbcs. dll/article? AID=2002208010304 Steinhaus, J. E. , Evans, J. A. , & Frazier, W. T. (1973). The physician assistant in anesthesia? Anesthesia and Analgesia,