Letter: Don’t go under with only a nurse
Senate Bill 1019 proposes to allow certified registered nurse anesthetists the ability to provide anesthesia care without the oversight of physician anesthesiologists. As the chief of anesthesia at one of Michigan’s largest hospitals and a retired Air Force physician, I believe this is a risky proposal.
Anesthesia and flying planes is very similar. Takeoffs and landings are like going to sleep and waking up. These are higher risk times in flight and during anesthesia and the entire flight or surgery duration poses ongoing risks and challenges. Like aviation, events during anesthesia can occur quickly and have devastating consequences. A recent example of what can go wrong was the death of the comedian Joan Rivers in 2014 during a simple outpatient laryngoscopy.
Our health care industry can learn much from aviation regarding safety. While anesthesia has been a leader in patient safety in health care, we are not even close to the safety performance of aviation. Earlier this year we saw the results of a Johns Hopkins study that estimates that medical errors are the third leading cause of death in the U.S., claiming 250,000 lives per year. That is a big number. That is like over 1,600 737 plane crashes per year. The aviation industry does not tolerate one crash and health care should not either.
Our most common anesthesia care model in Michigan utilizes a “care team model” that mimics the cockpit of a commercial aircraft. There is a supervising doctor anesthesiologist and a certified registered nurse anesthetist looking after all patients. The doctor anesthesiologist is the captain of the flight and has approximately 15,000 hours of clinical patient care as part of their training.
The nurse anesthetist is the co-pilot and they typically undergo 1,650 hours of clinical anesthesia training prior to certification. They each have complementary and collaborative roles in the provision of safe anesthesia care. What makes this model work so well is, like a commercial flight, there are two trained professionals overseeing care. This model improves safety by mitigating against one of the most common human factor causes of medical error: individual error.
Anesthesia care is like aviation; it is risky and technical, where the routine can become disastrous. Michiganians deserve the best and safest anesthesia care our industry has to offer.
My question for legislators considering this proposal: Would you board an aircraft with just a co-pilot in the cockpit?
Dr. Matt McCord, chief of anesthesia
Beaumont Dearborn Hospital