February 20, 2010

Letter to the Editor: Head of anesthesiologist group says nurse anesthetists are safe

Dr. Robert F. Koebert, president of the Wisconsin Society of Anesthesiologists, says in a letter to RacinePost that the Wheaton-Franciscan's decision to provide anesthesiology services with a combination of doctors and nurses is a safe model that is used throughout the country.

His comments are similar to comments from Lawrence Beck, president of the Wisconsin Association of Nurse Anesthetists, we reported on Jan. 4 when it was first revealed publicly that Wheaton had cut ties with its anesthesiologists and was replacing them with a private contractor from Florida. (The JT picked up on the story this week - over a month later.)

Local surgeons are concerned about the switch, saying it reduces the quality of service provided to surgical patients.

Here's Dr. Koebert's letter:
There has been a recent change in the delivery of anesthesiology services at Wheaton Franciscan-All Saints Hospital in Racine. Questions have been raised as to whether or not these changes compromise the quality and safety of patient care in that institution. As President of the Wisconsin Society of Anesthesiologists I wanted to take this opportunity to address these concerns.

Though the Milwaukee area tends to be dominated by a model of anesthesia care being delivered entirely by physician anesthesiologists, the most common method of care across the state and, indeed, the country utilizes what is known as the “anesthesia care team”. This model utilizes physician anesthesiologists in conjunction with non-physician anesthesia providers such as Certified Registered Nurse Anesthetists (CRNA’s) and Anesthesiologist Assistants (AA’s).

The anesthesia care team is directed by a physician anesthesiologist. The anesthesiologist is responsible for managing anesthesia care team personnel, pre-anesthetic evaluation of patients, prescribing the anesthesia plan, managing the anesthetic and participating in critical parts of the anesthetic and post-anesthesia care. The anesthesiologist remains immediately available to assist with management at any point in the anesthesia care. Medicare standards would allow one anesthesiologist to direct up to four procedures simultaneously. The Wheaton model being utilized allows for a single anesthesiologist to direct no more than two anesthetics at a time.

Surgery is a complex endeavor and the relationships between all members of the team are very important to the care of the patient. An abrupt change in the dynamics of the surgical team may well be disconcerting but the model of care outlined for Wheaton Franciscan-All Saints is one that is associated with high quality patient care and is fully supported by the American Society of Anesthesiologists as well as the Wisconsin Society of Anesthesiologists.

Robert F. Koebert, M.D.

22 comments:

  1. I have worked with CNRA's during my career many are very capable just like I have worked with many Anesthesiologists that are very capable. Do not judge by the title judge by their capabilities.Just like any job you have the good and the not so good. The ones working now are very very capable! You can rest assured that if you need surgery you will be well cared for for by the whole team .(CNRA,Surgeon,Nurse,Surgical Tech.,)

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  2. Well, I may just be old fashioned but when I am on the table I want the undivided attention of the DOCTOR giving me the gas and not have him directing some other surgery while I am under. Frankly, if I was scheduled for surgery and upon questioning learned that anyone other than the DOCTOR was going to handle my anesthesiology I would look somewhere else. The reason a nurse is not a doctor is TRAINING and EDUCATION. Every surgery should be handled by the doctors and not the B-team.

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  3. I totally concur with the immediate previous comment.

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  4. Orwell in the O.R.

    http://www.gaspasser.com/animalfarm.html


    !

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  5. We all know what happened to Michael Jackson. If Jackson can show up dead after a medical doctor without a specialty in anesthesia administers a drug I sure as hell do not want to have a nurse anesthetist doing it even with training.

    I'm quite sure there are good nurse anesthetists out there but there are very good reasons why medical doctors are trained as anesthesiologists. Your life is in the hands of the anesthesiologist. If a problem occurs there may not be time to get the supervising MD anesthesiologists back to the operating room in time to handle the problem.

    If I have a choice of a hospital to go to that uses medical doctors as anesthesiologists or a nurse anesthetist I will always choose the hospital who exclusively uses medical doctor anesthesiologists simply because of the difference in training and knowledge.

    The motive for using nurse anesthetist's is profit related. Wheaton is making more money doing so. Just because others are getting away with it elsewhere is no reason to justify it here.

    We want the MD anesthesiologists back at All Saints. Wheaton, make it happen otherwise we will vote with our feet and go elsewhere. Kenosha and Milwaukee all use them and our insurance will still cover it.

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  6. Yes, you can see how many problems Wheaton has had since going to CNRA's. Surgeries are being botched everyday, right?

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  7. I will "NEVER" have surgery with this current anesthesiologist situation. I was leary to have surgery there previously. Now they have convinced me to go elsewhere.

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  8. I had surgery 3 weeks ago and can tell you that it was professionally done, no botches, no problems. They know what they are doing and I have nothing but praise for them at a job well done.
    Thank you all at All Saints surgical care.

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  9. It is a fact that the Mayo Clinic uses the same model for Anesthesiologists.

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  10. Doesn't make it right or safe!

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  11. Even some of the most critical of the surgeons seem to feel the transition to the new anesthesiologist/CRNA team model is going more smoothly than they expected. Some are even saying certain aspects of anesthesia are now better than they were.

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  12. Self praise is no recommendation.

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  13. Of course this idiot is going to defend CRNA's He's making money off them. Duh!

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  14. Maybe everyone making negative statements about CRNAs should brush up on their history. Nurse anesthetists have been providing anesthesia longer than anesthesiologists. Not to mention that every study performed to date says that CRNAs and Anesthesiologists have equal track records when it comes to safety and providing care in an anesthesia care team model has been shown to improve patient outcomes/safety.

    -Kansas CRNA

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  15. This guy Koebert is Head of an Anesthesiologists group that employs Nurses. Of course he will say that they are safe.

    The way it works is, there is one anesthesiologist who is supervising 2 operating rooms with one nurse in each room. That way he can make double the money. This Florida Anesthesia group is a corporate group. All the profits go to the owners of the company. The anesthesiologists and CRNAs who are employed by this new group at All Saints have no vested interest in our community. The old group lived here for 20 years and the administration treated them badly so they left and went to Kenosha Aurora and Burlington Aurora. Their kids grew up in Racine and they went to the same churches as us. And now we have this fly-by-night group out of florida full of misfits. It is all about money my friends!!!

    I cannot imagine a nurse doing my anesthesia if I am having heart surgery or something major. Thankfully I have the option to go elsewhere. Probably Kenosha or Burlington!

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  16. I wonder how much he got paid by Wheatons to say that nurses are safe. This guy is a politician. If you google him, you will realize that he is just another sleazebag who speaks two different things from different sides of his mouth. Maybe he will get the contract next when they get rid of the Florida group?

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  17. There are three groups of professionals who may receive anesthesia training: dentists, nurses and physicians. I was trained as a nurse to do anesthesia 25 years ago. I have worked in various practice settings with and without the "supervision" of an anesthesiologist. The anesthesia care team approach is a great model in which I believe the safest anesthesia is provided. I would want two for one any day of the week if I was on the table!

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  18. Those who have given negative comments concerning CRNAs, and an unfounded fear of receiving an anesthetic from a qualified CRNA, apparently have not researched the educational requirements needed to become a nurse anesthetist. Nurse anesthetists must have a B.S. in nursing. Then they must work one to two years in an intensive care area where they obtain critical care experience. Next they are screened for admission to a Masters Degree program in Nurse Anesthesia. CRNAs are advanced practice nurses who have received intense training in anesthesia. The public need not fear that the CRNA administering their anesthetic is not well trained. As a CRNA for over 30 years I am proud of my profession and the good people of Racine can take comfort in the anesthesia care team model used at All Saints Hospital.

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  19. For all the nay sayers out there that will never have anesthesia delivered by a CRNA, I have news for you, you probably already have!
    You have to ask yourself like in the airline bussiness, who would you trust to fly the plane? The person that flies everyday or somebody that needs to get their quarterly/annual hours in.

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  20. CRNA's have been performing a vast majority of anesthesia in the military since the 1960's. And on a collaborate role with anesthesiologists since 1990's. They are by themselves at FOB performing solo anesthesia on our troops in Afgahnistan and IRAQ. I guess there's not enough money for the DOCs to get enough in country

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  21. In the VAST majority of hospitals, anesthetics are administered by CRNAs. Why don't people know this? Because the person you are introduced to in the waiting area is an anesthesiologist. Then, after you have been sedated, you are taken to the OR where a CRNA provides your anesthesia while the anesthesiologist drinks coffee and reads the newspaper. Later, the anesthesiologist comes to the recovery room and discharges you, so naturally that's who you remember (and thank, and praise), even though that wonderful anesthesiologist may have never even set foot in the operating room.

    Personally, I WOULDN'T want an anesthesiologist to put me to sleep, because a lot of them haven't given anesthesia since they were residents. Ask an OR nurse -- CRNAs are not 'the B team', they are the ones who actually do the work. Doctors complain when they have to sit in the OR with a patient for 15 minutes to give a CRNA a break.

    If you want to talk about money, here's one for you -- specially trained nurses always provided anesthesia, because doctors didn't want to until insurance companies started paying for anesthesia separately. Then, the medical specialty of 'anesthesiology' was born! By the way, you do NOT have to be board certified to call yourself an anesthesiologist.

    Ask around at the other hospitals, and you will find that they use CRNAs too. You'll have to dig deep, because they intentionally put the anesthesiologists "out front" and the CRNAs "in the back". But in the back is where the actual anesthesia takes place.

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  22. just linked this article on my facebook account. it’s a very interesting article for all.



    Anesthesia Billing Services

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