Nonoperating room anesthesia cases are expected to account for more than 50% of all anesthesia cases in the next decade, according to a June 2024 report by the American Hospital Association and the American Society of Anesthesiologists.
The increase in the use of anesthesia outside of the traditional operating room setting is attributed to innovations in minimally invasive surgeries, the rise of ASCs as a preferred option for outpatient surgical procedures and the increased demand for surgical procedures as the U.S. population ages and faces increased comorbidities.
The rise in demand for NORA is linked with an ongoing workforce shortage in anesthesia, amounting to a cyclical challenge facing healthcare organizations across the U.S.
Here are three things to know about the rise of NORA and its impact on anesthesia providers:
1. Resource allocation remains one of the biggest challenges facing anesthesia providers amid the rise in NORA. According to an October 2024 report by Enhance, a healthcare consulting group, there are several aspects of resource allocation that anesthesia practices must prepare for as they navigate an increase in NORA procedures. This might include investing in portable and adaptable equipment that can be easily transported, as some NORA sites may lack specialized equipment or immediate access to emergency supplies.
2. Anesthesia providers may need to expand their skillsets to adapt to the unique challenges of NORA sites. Additional certification may be a consideration for providers who require further experience outside the traditional operating room setting. This process is already underway for many anesthesia providers.
“…Our role as anesthesiologists continues to evolve not only as experts in anesthesiology, but now we are experts in perioperative medicine, researchers, teachers, leaders in operating room and non-operating room management and efficiency, and leaders in patient safety and quality,” Marky Hylton, MD, an anesthesiologist at the University of North Carolina at Chapel Hill, told Becker’s.
3. As the role of anesthesia providers continues to expand, efficiency and utilization will continue to be essential points of focus for anesthesia practices, hospitals, ASCs and other NORA sites.
Gavin Baker, CEO of New Orleans-based Krewe Anesthesia, told Becker’s that facility leaders will have to be open-minded and rigorous in their evaluation of anesthesia efficiency.
“Everybody, especially the surgeons, want to do as many cases as they can. Some surgeons want two to three rooms that they can bounce back and forth,” Mr. Baker said. “If you can be efficient with that, that’s great, but a lot of times that ends up costing decreased utilization in regards to anesthesia time. If you do the calculation and it makes sense to increase procedure count, you have to realize that may be an inefficient use of anesthesia, [even though] it is an efficient use of the surgeon’s time to give them multiple rooms.”
His practice works with facilities to align their financial needs with their anesthesia time utilization — a practice that involves thinking outside the box and finding a certain balance between the needs of the facility, providers and patients.
“There’s give-and-take there, because you’re going to have time where the anesthesia is now actually billing minutes when the surgeon is being more efficient. Sometimes that leads to less efficient anesthesia,” he said. “And as long as that give-and-take is upfront and calculated then, that’s fine. But I think sometimes they forget that just because the surgeon’s time is more efficient, doing it that way with multiple rooms, it may not necessarily be the case with anesthesia.”
