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Non-operating room anesthesia (NORA) defines the perioperative care for a diverse array of diagnostic and interventional procedures. From gastrointestinal endoscopy to cardiologic catheterization to cerebral angiography to diagnostic magnetic resonance imaging, the anesthetic challenge to deliver efficient, safe perioperative care is matched by its expansion and demand.

The APSF appropriately recognizes NORA as a patient safety priority understanding and foreseeing a rapidly developing, multi-disciplinary field. With this priority page, we aim to:
1. Establish of library of best evidence and practice guidelines, focusing on perioperative patient safety for NORA.
2. Develop sub-pages dedicated to each of the NORA specific practices
3. Support a community of multi-disciplinary NORA thought leaders and established practitioners
4. Identify opportunities for improvement and fortify pillars of safety in NORA

Closed Claims Data

Examination of closed claims databases provides insight into the potential adverse outcomes and vulnerabilities related to NORA procedures. The majority of NORA closed claims cases originated in the gastrointestinal endoscopy suite.3 This might be related to the sheer volume of cases performed there as compared to other venues.

Patients undergoing NORA procedures, compared to those performed in the operating room, have a higher frequency of severe injury and death.4–6 In more than half of NORA-related claims involving deaths, patients were deemed to have received substandard anesthesia care preventable by improved monitoring techniques.5 Suboptimal care and failure to provide safe practice were seen as the leading cause of poor outcomes.3 Most claims were related to respiratory events, specifically inadequate oxygenation and/or ventilation.5,6 Monitored anesthesia care was the most common anesthetic technique used, contributing to 50% of claims.5 Oversedation leading to respiratory depression was implicated in a third of

The NORA Expanse

Further information: Growth of Nonoperating Room Anesthesia Care in the United States

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