Comparative effectiveness and safety of physician and nurse anaesthetists: a narrative systematic review.
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.


METHODS
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.
Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK. andrew.smith@rli.mbht.nhs.uk
A F
AF
Smith
M
M
Kane
R
R
Milne
D000776:Anesthesiology / Q000458:organization & administration*; D002983:Clinical Competence; D003695:Delivery of Health Care / Q000458:organization & administration; D019317:Evidence-Based Medicine; D006302:Health Services Research; D006801:Humans; D008505:Medical Staff, Hospital / Q000592:standards*; D009719:Nurse Anesthetists / Q000592:standards*; D009722:Nurse Practitioners / Q000592:standards*