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• W3135859211 abstract "BackgroundThe Non-Medical Surgical Assistant (NMSA) is a clinician; who is not a Medical Practitioner, who provides perioperative care. This research focused on the care provided by the NMSA during the intraoperative phase of the perioperative cycle. During the intraoperative phase, the surgical assistant is an integral part of the surgical team, working directly with the primary surgeon to optimise patient outcomes.In Australia, nurses have been performing the role of the NMSA for more than 30 years, yet this specialty practice role is unregulated by the Nursing and Midwifery Board of Australia (NMBA). Similarly, Medicare does not recognise the nurse as a legitimate provider of intraoperative surgical assisting care. No Medicare rebate means the patient incurs an out of pocket expense.AimThis research aimed to investigate how the role of the NMSA is practised internationally; and who is currently practising the role in Australia. With this information, the objective was to consider if the NMSA in Australia is a legitimate role which provides effective care compared to the traditional role of the Medical Surgical Assistant (MSA). The final goal was to examine if the role of the NMSA in Australia facilitated equity within the Australian healthcare system.MethodsUtilising three of the Pillars of Quality, from Donabedian’s quality in healthcare framework, this research investigated the legitimacy, effectiveness and equity of the NMSA in Australia.Survey methodology of key stakeholders investigated the legitimacy of the NMSA role. Examination of peak professional bodies’ standards and position statements; and exploration of government policy, regulation of scope of practice and the law were additional strategies used to establish if the NMSA role was legitimate in Australia.A retrospective, cohort study of patient outcomes utilising administrative data; for the NMSA with the comparator of the MSA; provided the method for exploring effectiveness. Each patient received intraoperative care from a consultant surgeon and a Medical Surgical Assistant or Non-Medical Surgical Assistant. The effect that surgical assistant choice had on patient outcomes was estimated using statistical regression models. Six dependent variables including time in theatre and intraoperative time; admission to Intensive Care, Length of Stay, discharge destination and readmission after discharge were specified. Continuous variable models were estimated with ordinary least squares (OLS) and dichotomous variable models were estimated as probit regressions. For continuous variable models, the normality of the dependent variables were tested using a Shapiro and Wilk (1965) test. If the p-value for the test statistic (W) was less than 0.05 the assumption of normality was rejected and the dependent variable was log transformed. All coefficients were reported with robust standard errors.  The null hypothesis (H0:α1= 0); surgical assistant choice has no effect on patient outcomes was rejected if the p-value > 0.05. Data analysis was undertaken using the STATA 15.1 Statistics/Data Analysis program.A pyramid illustration offered a configuration to consider equity with the platform of the pyramid being access to surgical care for the patient. Administrative data from regional hospitals enabled investigation of the NMSAs impact on access to surgical care. The second tier of the pyramid investigated remuneration of the NMSA, and the final tier, cost to the patient when an NMSA was part of the surgical team. Acquisition of each tier of the pyramid was necessary to achieve the pinnacle of equity for the surgical patient, in the context of the NMSA.ResultsMultiple levels of nurses; Physician’s Assistants and Allied Health Professionals undertake the role of NMSA in Australia. Internationally NMSA roles that have tertiary education of a Master’s degree, a standardised curriculum, national regulation and title protection are autonomous and professionally recognised NMSA roles.Surgeons and perioperative staff supported the Registered Nurse (RN) and Nurse Practitioner (NP) as a surgical assistant, and perioperative staff perceived that the NMSA with a high level of education added more value to the surgical team.  According to peak professional bodies, both the RN and NP are legitimate providers of surgical assisting care in Australia; however, the NP is the only nurse with an advanced scope of practice regulated by the NMBA. Similarly, the NP is an eligible provider of some services on the Medical Benefits Schedule and is a lawful provider of medical and professional services.In Australia, both the RN and NP provided effective care as a surgical assistant compared to the MSA. The cohort study showed no statistically significant or clinically relevant difference in patient outcomes between the RN or NP as NMSA; and the MSA.The RN and NP also increased equity in the Australian healthcare system with improved access to surgical care in the private sector. Access was improved if the surgery was urgent, required highly specialised skills or if no MSA was available as was the case in regional Australia. Equity was decreased by government policy related to the lack of a Medicare rebate for the patient.ConclusionThe RN and NP are effective providers of surgical assisting services and enhance equity through increased access for surgical patients in the private healthcare sector. From many aspects both of these clinicians are legitimate providers of NMSA services; however, the lack of advanced practice regulation, scope of practice and lack of access to the Medical Benefits Schedule for the RN renders the NP a more legitimate clinician to perform the role of the NMSA in Australia. Expanded access to Medical Benefits Schedule rebates for the patient of the NP providing NMSA services would enhance equity for the patient." @default.
• W3135859211 created "2021-03-15" @default.
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• W3135859211 date "2021-03-02" @default.
• W3135859211 modified "2023-09-26" @default.
• W3135859211 title "The role of the non-medical surgical assistant in Australia: legitimacy, effectiveness, and equity" @default.
• W3135859211 doi "https://doi.org/10.14264/8da0a16" @default.
• W3135859211 hasPublicationYear "2021" @default.
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