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Dental Survey 2009. A survey to assess the anesthesia needs and practices of Arizona dentists. Prepared by the Arizona Association of Nurse Anesthetists. Dental Survey 2009. Approximately 1300 postcards mailed to invite dentists to participate Response from 64 (4.9%).
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Dental Survey 2009 A survey to assess the anesthesia needs and practices of Arizona dentists Prepared by the Arizona Association of Nurse Anesthetists
Dental Survey 2009 Approximately 1300 postcards mailed to invite dentists to participate Response from 64 (4.9%)
Do you use outside anesthesia providers in your dental practice? Total of 64 respondents. One half (32) did not continue in the survey.
Approximately how many dental cases in your office require anesthesia from an outside provider each month? n = 30
Which of the following anesthesia providers have you used or do you currently use in your practice? n = 29; Other category includes OMFS & hospital-based providers (all)
Do you have a preference for your anesthesia provider? n = 29; see comments on next slide
Do you have a preference for your anesthesia provider? A dentist anesthesiologist provides a cost effective and hassle-free way of treating patients in the office. Most importantly, the operating dentist does not need a 1301 permit when working with a dentist anesthesiologist. It is extremely convenient to work in the dental office compared to a surgery center. Physicians are unpredictably prepared for outpatient anesthesia (some are excellent, others are not). Regarding CRNA---who is responsible? The dentist overseeing the CRNA...this doesn't make sense. I would rather use someone well-trained, liable for their own actions, vested. The dentist is indirectly responsible for the actions of the CRNA and if there is an adverse event, the dentist will surely get named (even if they are not directly responsible for the anesthesia provided by the CRNA). I prefer dental anesthesiologists--the risk is the lowest. Dental anesthesiologists are better trained for the dental office environment. No additional dental board certification is required to work with a dental anesthesiologist. The dentist providing anesthesia for my patients is extremely well qualified to work in this type of practice setting. I would not be comfortable or trust any other type of provider. Dental anesthesiologists are extremely well trained and very understanding of the needs of patients in the dental office setting. No preference but have only been contacted by one provider. Would change if costs lower w/ same great results.
If you have worked with a CRNA were you satisfied with the anesthesia care delivered? n = 28; see comments on next slide
If you have worked with a CRNA were you satisfied with the anesthesia care delivered? I would not work with a CRNA. I would not feel comfortable with her level of training. The CRNA was not trained with pediatrics and needed help (during) the case from the dentist anesthesiologist. I don't believe nurses are qualified to treat patients without appropriate supervision. CRNA's are not qualified to work in the dental office setting nor can they per the Dental Board regulations. CRNAs do not possess the experience and knowledge to properly function in a dental office for the provision of anesthesia.
Did you know that a dentist is not medically legally responsible for anesthesia provided by a CRNA? n = 29
Are you aware of the efforts by the Board of Dental Examiners (BODEX) to change the dental anesthesia permits that regulate anesthesia providers in dental offices? n = 29
Have you made changes in your anesthesia provider(s) based on the discussion / actions by BODEX regarding the anesthesia permits? n = 29; see comments on next slide
Have you made changes in your anesthesia provider(s) based on the discussion/actions by BODEX regarding the anesthesia permits? Can only use dental anesthesiologists in office due to oversight turf wars. Cannot use CRNA's in my new independent practice because of the Board decisions. If the patient is affected negatively from anesthesia, everyone suffers, no matter what BODEX says. A dentist anesthesiologist is specifically trained to be part of the dental team. I would not feel comfortable working with a nurse in an unsupervised capacity with a patient under anesthesia.
Do you find the current anesthesia permits restrictive to your use of anesthesia providers? n = 29; see comments on next slide
Do you find the current anesthesia permits restrictive to your use of anesthesia providers? Can only schedule patients for in-office anesthesia when dental anesthesiologist is in town. All dentists should pass a separate certification whenever another provider performs IV sedation or GA in the dental office. There should be no difference in certification for the restorative dentists regardless even if a non-dental anesthesiologist provides the service. A HIGHER standard of universal sedation certification should benefit the patient and not restrict a market segment. SURVEY COMPLETE
What are the underlying concerns with dental anesthesia in Arizona, as learned from the survey? • Qualification / education of nurse anesthetists • Cost of dental anesthesia • Availability of dental anesthesiologists • Different and confusing anesthesia permits
Qualification / education of nurse anesthetists • A Bachelor’s of Science in Nursing (BSN) or other appropriate baccalaureate degree. • A current license as a registered nurse. • At least one year’s experience in an acute care nursing setting. • Graduation from an accredited graduate school of nurse anesthesia. These educational programs range from 24-36 months, depending upon university requirements, and offer a master’s degree. • All programs include clinical training in university-based or large community hospitals. • Pass a national certification examination following graduation. • It takes a minimum of seven calendar years of education and experience to prepare a CRNA. The average student nurse anesthetist works at least 1,694 clinical hours and administers more than 790 anesthetics.
Cost of dental anesthesia • Billing / reimbursement is the same for all anesthesia providers. • The difference lies in the premium rates charged by individual providers
Availability of dental anesthesiologists • Total of 10 dental anesthesiologists in Arizona • 21% of dentists practice in rural Arizona • This requires a lot of traveling and less availability • Approximately 20-30 CRNAs in Arizona that practice dental anesthesia • All 500 CRNAs with Arizona licenses are prepared to give dental anesthesia
Dental anesthesia permits (current) • 1301: permits the administration of GA or deep sedation • permit holder must complete an anesthesiology training program (this permit held by dental anesthesiologists) • permit holder may employ a CRNA to administer the GA under the supervision of the dentist • 1302: permits the administration of IV conscious sedation • 1303: permits the administration of oral conscious sedation
Dental anesthesia permits (proposed) • 1301: • 1302: this permit of little concern to CRNAs • 1303: CRNAs not effected • 1304: new permit to employ or work with a physician anesthesiologist • CRNAs can only work under the direction of the MDA who is NOT providing simultaneous anesthesia
