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Investigators target research at VA hospitals
Study: Anesthesia provider credentials don't affect surgical death rates
Organization releases emergency nurse staffing guidelines

Patient Safety Monitor Alert, April 28, 2003

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INVESTIGATORS TARGET RESEARCH AT VA HOSPITALS

Investigators are cracking down on research departments at veterans' hospitals across the country for possibly jeopardizing the safety of their subjects. The Department of Veterans Affairs (VA) is conducting a massive review of medical research-related patient deaths in VA hospitals and has shut down a number of studies, according to the International Herald Tribune.

Investigators found that a patient at a Detroit hospital died as the result of a large prescription drug overdose last year. At a VA hospital in North Dakota, investigators halted all research in February after finding that since September, one patient had died and 22 had suffered adverse reactions to drugs taken as part of a study. And in a Fargo, ND hospital, the doctor listed as responsible for patients in one clinical trial said that he didn't know or consent to the listing, according to the Herald Tribune.

Dr. Nelda Wray, the new director of the veterans research program, ordered the investigation of 115 VA hospitals across the nation after she learned about cases in which researchers falsified study data and failed to tell patients about the risks associated with participation in the studies.

STUDY: ANESTHESIA PROVIDER CREDENTIALS DON'T AFFECT SURGICAL DEATH RATES

If certified registered nurse anesthetists (CRNAs) provide anesthesia at your hospital, your patients may not be any more or less at risk than if you used physician anesthesiologists or some combination of the two, according to a new study published in the American Association of Nurse Anesthetists' (AANA) April 2003 AANA Journal.

Researchers analyzed 404,194 cases in 22 states to find out whether different types of anesthesia providers affected how frequently Medicare patients who were undergoing surgery died. They found that no matter whether anesthesiologists or CRNAs provided the anesthesia by themselves or in teams, patient death rates remained similar.

"With the demand for surgical care and other procedures requiring anesthesia growing annually, and an insufficient number of qualified anesthesia providers to satisfy this demand, it is important that the current supply of CRNAs and anesthesiologists be used effectively," said Rodney C. Lester, CRNA, PhD, president of the AANA, in a press release from AANA. Not everyone agree that CRNAs should have the ability to anesthetize patients by themselves. For instance, anesthesiologists in Colorado are sued the state's governor earlier this year to keep him from exempting the state from federal Medicare rules that require a physician to supervise nurses that administer anesthesia.

Go to http://aana.com and click on "press releases" to read the study, entitled "Surgical Mortality and Type of Anesthesia Provider."

ORGANIZATION RELEASES EMERGENCY NURSE STAFFING GUIDELINES

Fed up with trying to guess how many nurses should be on duty in your hospital's emergency room? The Emergency Nurses Association (ENA) may be able to help. The association recently launched staffing guidelines for emergency department (ED) nurses. According to a press release from the ENA, the guidelines will help hospitals calculate

- ideal staffing levels, based on census, patient acuity, and length of stay
- time it will take nurses to perform their duties based on patient acuity
- which skills a non-registered nurse should have in order to provide patient care
- how to factor non-patient care time into a nurse's position

An ENA workgroup of nursing professionals developed the guidelines after reviewing literature on staffing and workload issues, as well as parameters for ED coding and billing. Go to www.ena.org to purchase a guide and a CD/ROM containing the guidelines for $100 (if you are a member of ENA) or $500 (if you are not).

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