Hospitals nationwide are facing a new anesthesia challenge. As procedures requiring anesthesia move outside the operating room — into diagnostic imaging, endoscopy, pain management, and other non-traditional settings — Non-Operating Room Anesthesia (NORA) is rapidly expanding. 

In large hospitals, NORA cases have grown from roughly 20% to 35% of total anesthesia volume, with forecasts suggesting they could reach 50% by 2030. This growth is colliding with an ongoing anesthesia staffing crisis — creating major operational strain on OR performance, scheduling, and financial outcomes. 

Here are five strategies every perioperative leader should consider: 

1. Include NORA in Governance 
NORA services often operate without formal leadership. Appointing an anesthesia leader to represent NORA in governance ensures consistent resource planning and patient safety standards. 

2. Centralize Scheduling 
Paper-based or siloed scheduling systems make it impossible to optimize staffing. Centralized, digital scheduling helps balance anesthesia availability across all procedural areas. 

3. Leverage Real-Time Data 
Replace static reports with real-time dashboards that highlight coverage gaps, case delays, and emerging trends before they affect OR throughput. 

4. Use Acuity to Guide Staffing 
Not all NORA cases are low risk. Incorporating ASA classification and patient acuity into daily scheduling helps allocate the right level of expertise where it’s needed most. 

5. Standardize Equipment and Support 
NORA sites should have consistent access to the same anesthesia equipment, supplies, and technical support as the OR to ensure safety and efficiency. 

The Bottom Line 
NORA isn’t going away — it’s redefining the boundaries of anesthesia care. By integrating NORA into your operational and analytical framework, you can protect OR capacity, strengthen safety, and align resources with real demand. 

To see how Medaxion’s Anesthesia Manager provides real-time visibility and data-driven recommendations to manage NORA and OR coverage together, visit www.medaxion.com/anesthesia-manager.