An examination of factors contributing to different anesthesia models in underserved areas.

Abstract

Background: Maternity care access is worsening across the United States, driven in part by difficulties staffing obstetric units in some hospitals. Certified registered nurse anesthetists (CRNAs) provide obstetric anesthesia services in underserved areas, including rural areas (Cohen et al., 2021; Martsolf et al., 2019), areas with low delivery volumes (Kohzimannil et al., 2015) and areas with more vulnerable populations (Liao et al., 2015).

Purpose: This study examines the characteristics of hospitals that rely on CRNAs to provide anesthesia services in their obstetric departments, including hospital-level characteristics and state-level policy decisions.

Methods: We use an exploratory and explanatory sequential mixed-method design that relies on two series of key informant interviews and a survey of CRNAs practicing obstetric anesthesia.

Discussion: We find that CRNAs practice without medical direction more frequently in areas where fewer maternity care services are available, indicating that CRNAs may be filling an important vacancy in access to care.

Conclusion: Findings support the idea that CRNAs are vital in areas which would otherwise lack anesthesia providers and obstetric services. Policies that support hospitals in allowing CRNAs to practice without medical direction may increase access to hospital obstetric anesthesia services in underserved areas.