Boggs Steven D, Barnett Sheila R, Urman Richard D
aDepartment of Anesthesiology, University of Tennessee Health Sciences Center, Memphis, Tennessee bDepartment of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center cDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts, USA.
Curr Opin Anaesthesiol. 2017 Dec;30(6):644-651. doi: 10.1097/ACO.0000000000000528.
Nonoperating room anesthesia (NORA) has grown from an insignificant percentage of total anesthesia cases into a major percentage of anesthesia workload over the past 30 years. This trend evidences no signs of abating.
With the rapid development of novel interventional techniques in cardiology, radiology, gastroenterology and pulmonary medicine and other areas, the core responsibilities of the anesthesia provider will no longer be confined to delivering care in traditional operating rooms. This change presents challenges for the profession on several fronts. Efficient staffing of multiple locations poses challenges. The demand for anesthesia services continues to increase, but underutilization is a major problem. Each clinical area presents unique patient care issues. New interventional techniques are continually developed with which anesthesiologists need to be familiar in each specific area. NORA patients are older and medically complex, yet many are treated on an outpatient basis. Consequently, anesthetic management for NORA will of necessity require techniques that allow patients to recover quickly.
It may be anticipated that in the next decade that NORA cases will constitute over 50% of the number of cases performed with anesthesia involvement. As the last century belonged to invasive surgery, the next century will belong to interventionalists. There is also an increasing national emphasis on quality measurement and metrics reporting. Future anesthesia payment models under Medicare Access and CHIP Reauthorization Act, such as merit-based incentive payment system (MIPS), emphasize various process and outcomes measures. Anesthesiologists will be evaluated based on a composite performance score consisting of four components: quality, resource use, clinical practice improvement activities and meaningful use of certified electronic health record technology.
综述目的：在过去30年里，非手术室麻醉（NORA）在总麻醉病例中所占比例从微不足道增长到占据麻醉工作量的很大一部分。这种趋势没有减弱的迹象。
最新发现：随着心脏病学、放射学、胃肠病学和肺病学等领域新型介入技术的迅速发展，麻醉提供者的核心职责将不再局限于在传统手术室提供护理。这一变化在多个方面给该行业带来了挑战。多个地点的高效人员配置带来了挑战。麻醉服务需求持续增加，但利用不足是一个主要问题。每个临床领域都存在独特的患者护理问题。新的介入技术不断涌现，麻醉医生需要熟悉每个特定领域的这些技术。NORA患者年龄较大且病情复杂，但许多患者是门诊治疗。因此，NORA的麻醉管理必然需要能让患者快速恢复的技术。
总结：可以预计，在未来十年，NORA病例将占涉及麻醉的病例总数的50%以上。正如上个世纪属于侵入性手术一样，下个世纪将属于介入专家。国家对质量衡量和指标报告的重视也在增加。根据《医疗保险准入和儿童健康保险计划再授权法案》制定的未来麻醉支付模式，如基于绩效的激励支付系统（MIPS），强调各种过程和结果指标。麻醉医生将根据由四个部分组成的综合绩效得分进行评估：质量、资源利用、临床实践改进活动以及对认证电子健康记录技术的有效使用。
