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BJA Advance Access published online on August 6, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh240
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted June 11, 2004

Clinical Investigation

Comparative effectiveness and safety of physician and nurse anaesthetists: a narrative systematic review{dagger}

A. F. Smith 1*, M. Kane 1, R. Milne 2

1 Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
2 Wessex Institute for Health Research and Development, University of Southampton, Southampton, UK

* To whom correspondence should be addressed. E-mail: andrew.smith{at}rli.mbht.nhs.uk.


  Abstract

Background. Despite widespread debate on the merits of different models of anaesthesia care delivery, there are few published data on the relative safety and effectiveness of different anaesthesia providers.

Method. We conducted a systematic search for, and critical appraisal of, primary research comparing safety and effectiveness of different anaesthetic providers.

Results. Our search of Medline, EMBASE, CINAHL, and HMIC for material published between 1990 and April 2003 yielded four articles of relevance to the question. The studies used a variety of methodologies and all had potential confounding factors limiting the validity of the results.

Conclusions. In view of the paucity of high-level primary evidence in this area, it is not possible to draw a conclusion regarding differences in patient safety as a function of provider type. There are difficulties in classifying events as ‘anaesthesia-related’, and also in the variable definitions of ‘supervision’ and ‘anaesthesia care team’. We suggest that existing attempts to show differences in outcome might usefully be complemented by studies examining measures of anaesthetic process.

Keywords: anaesthesia, audit; anaesthesia, personnel; organizations, health care; safety, anaesthesia providers.

{dagger} This publication is derived from the project ‘Exploring professional boundaries in anaesthetics: a systematic review’ which was funded by the United Kingdom National Health Service National Co-ordinating Centre for Service Delivery and Organisation Research and Development (NCCSDO). We would like to thank the members of the Expert Advisory Group convened for the project, and medical information specialists Paul Longbottom and Lesley Sander. Views expressed herein are those of the authors and are not necessarily those of the NCCSDO or the UK Department of Health.


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