Understanding Safety And Systems-factors In Non-operating Room Anesthesia: A Survey.

Non-operating room anesthesia (NORA), or anesthesia delivered outside the traditional operating room (OR) setting, is projected to represent at least 50% of all anesthesia cases over the next decade. NORA cases include those in settings such as the gastroenterology, cardiology, interventional radiology, and psychiatry suites. On average, patients in NORA settings are older and sicker than those seen in the OR, and anesthesia providers are challenged to take care of such patients in new, fast-paced, high-volume environments that may or may not be optimized for anesthesia care. As caseloads increase, these underlying systems issues significantly increase the potential for preventable adverse events. In fact, previous literature has shown that NORA cases may have higher rates of morbidity and mortality associated with anesthesia administration compared to the operating room. Despite this, there is limited literature examining the nature of NORA-related adverse events or quantitative evidence examining how system factors may contribute to such events. In our research, we surveyed anesthesia providers at a large academic medical center to investigate their experiences with near-miss (narrowly avoided events that had the potential to lead to patient harm) and patient harm events in NORA settings