Hospitals or Ambulatory Surgery Centers - Which Setting Is Better for CRNAs?

by
Bhairavi KS
September 30, 2021

Certified Registered Nurse Anesthetists (CRNAs) play a crucial role in the perioperative experiences of patients. Not only do they work in hospital-based operating rooms, but also in obstetrical suites, chronic pain clinics, and dental offices. As a profession, nurse anesthesia has greatly evolved since its days in the Civil War where it was used to treat surgical wounds and injuries. The ambulatory surgery setting has, therefore, become a more common environment for anesthesiologists to administer anesthesia.

Advancements in educational requirements, monitoring techniques, surgical innovations, and data-driven practice standards, have made anesthesia safer today than ever.

If you are looking to practice in an ambulatory surgery center or in a hospital setting, prioritize your work-life variables first. Often, the desire to care for a specific patient population or change pace influence the CRNA’s decision to move from one setting to the other. In this article, we discuss the five critical factors that can help nurse anesthetists decide between an ambulatory surgery center and hospital-based care setting:

Patient Acuity:

Ambulatory surgery centers (ASCs) maintain standards set by the healthcare staff to select patients, based on their health conditions. Since healthy patients recover faster and require fewer resources, ASCs serve as favorable environments for treatment. However, older patients and patients with comorbidities or severe systemic disease are excluded from the ASC setting, as they are best handled at tertiary care centers and hospitals that can cater to their preoperative diagnostic needs. Also, hospitals are better equipped to monitor patients for extended periods of time after surgery and can intensify their levels of care as necessary. ASCs, on the other hand, do not have these abilities.

Types of anesthesia administered:

Since ASCs tend to take on high volumes of cases that need quick treatment, the medication is carefully selected to help the patient recover from anesthesia without prolonging their stay. CRNAs must therefore be hands-on with acute pain management and regional anesthesia techniques. Ultrasound use, successful administration of peripheral nerve blocks, perioperative block management, and patient education are significant skills needed in an ambulatory setting. In an ASC, CRNAs are needed to administer regional anesthesia instead of general anesthesia, as it reduces the post-operative risk for nausea and vomiting, which might, in turn, prolong the patient’s stay.

On the contrary, in a hospital-based environment, surgical cases tend to be more complex than cases in ASCs. CRNAs in hospital-based settings need to be skilled in definitive airway management, invasive monitoring techniques, and titration of vasoactive infusions. There is a limit as to the number of patients hospitals can accommodate for such procedures. Those who require special care after major surgeries must be transferred to another type of facility which offers the same services under more controlled conditions; operating rooms, analytical labs, and pharmacies are examples of those facilities.

Types of surgical cases:

The number of patient cases in ambulatory surgery centers is growing daily. Some important procedures are now being done in the ASCs instead of hospitals. For example, arteriovenous fistula creation and orthopedic joint arthroplasty. Gynecological, dental, endoscopic, and cataract surgery are also becoming more common in ambulatory surgery centers.

Production Pressures:

There are different levels of pressure to perform depending on which type of facility you choose to work in. For instance, ASC's require higher case volumes of shorter duration. This implies that CRNAs have to work more quickly before moving on to the next case. Instead, hospital-based providers tend to have a lower case volume but still have to be just as fast. They also have paperwork and other responsibilities related to the patient's overall health over time, which could sometimes prove far more emotionally weighty than what ambulatory care might entail.

Scope of Practice:

The scope of practice for CRNAs varies state-wise. However, it is mostly influenced by institutional bylaws and policies. For example, although board-certified nurse anesthetists are capable of administering peripheral and neuraxial blockade, not all facilities may credential them to do so. It is always better to investigate the credentialing standards for the individual facility before applying to practice. Removing barriers to the scope of practice and permitting CRNAs to work up their full license improves patient access to care, efficiency, job satisfaction, and optimizes team-based outcomes.

The role of a certified registered nurse anesthetist (CRNA) provides a unique opportunity to work in a variety of clinical environments. In addition to hospitals, they may also work in outpatient surgery, emergency departments, or ambulatory surgical centers. Criteria for becoming a CRNA are detailed for each state and can be found with a quick internet search. The scope of practice restrictions can vary from state to state and will largely impact how a CRNA practices on a day-to-day basis.

If you are looking for CRNA opportunities, apply for jobs on directshifts.com.

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