A systematic review for the Royal College of Anaesthetists
With the UK’s National Health Service facing critical workforce shortages, the Royal College of Anaesthetists (RCoA) needed to better understand the role that non-physician providers of anaesthesia, such as anaesthesia associates (AAs), could play in delivering safe, effective care.
Despite being part of the UK system for over two decades, AAs remain unregulated and under researched with concerns surrounding patient safety, training implications and team dynamics. In light of this, RCoA commissioned our evidence consultancy service, Cochrane Response, to conduct a systematic review of evidence on non-physician anaesthesia providers, focusing on AAs and their comparators in high-income countries.
How Cochrane helped
Cochrane Response conducted a rapid systematic review, screening 6644 records. The findings were summarized into a clear, policy-relevant document, consisting of English language and non-English language sources within a few months. The mixed-methods review included both qualitative and quantitative data, offering a more complete picture of the evidence and attitudes on the topic.
This work enabled RCoA to understand a broad, international picture of how non-physician anaesthetists work as part of anaesthetic teams, as well as their impact on patient safety and interaction with other staff groups, particularly in high-income countries.
The review proved particularly valuable as it highlighted the low quality and risk of bias of the available evidence, preventing definitive conclusions. This finding provided important context for the Leng Review, a high-profile UK Government investigation commissioned by the Secretary of State for Health and Social Care, into the regulation and role of physician associates and AAs.
Why it worked
RCoA has championed several aspects of Cochrane Response's approach they found particularly valuable. Some of the key points focused on the speed, comprehensiveness, and clarity that Cochrane provides in their reviews.
The entire process, from initial record screening to final outcomes, was completed within a matter of months. This timely execution allowed for valuable contributions to a national policy debate. When faced with complex questions and a large, diverse body of literature, including material in multiple languages that can be difficult to identify and obtain, Cochrane Response delivered high-quality, reliable evidence in a clear and accessible way. This helped map international models of care and supported informed decision-making.
"Cochrane Response helped us understand a complex topic that health services worldwide are grappling with. Their ability to synthesize a large amount of literature, including non-English language literature, in a relatively short amount of time, was valuable."
– Peter Kunzmann, Head of Policy and Public Affairs, Royal College of Anaesthetists
Shaping policy, improving care
The review has helped shape RCoA's understanding of a fast-evolving workforce issue, supporting its strategic policy response and underscoring the need for more high-quality, UK-specific research. The reviews is now published in the British Journal of Anaesthesia.
The evidence, while limited, gave the College a more informed position in national policy discussions, particularly in response to the Leng Review. By highlighting both the known and unknown, Cochrane Response has helped RCoA speak with more confidence on the risks, benefits, and evidence gaps related to non-physician anaesthesia providers. This has also served as a useful reference point in wider conversations regarding workforce planning decisions.
“Working on policy issues like these is always a rewarding experience. We can apply our skills and expertise to respond to the needs of our clients and ensure they are fully informed. This enables them to better contribute to debates and consultations, ensuring decisions are based on the best possible evidence and improving outcomes for everyone.”
– Nicholas Henschke, Head of Cochrane Response
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