Frameworks for value-based care in the nonoperating room setting

Aakash Keswani, Brian Licht, Richard D. Urman

Research output: Contribution to journalReview articlepeer-review


Purpose of reviewNonoperating room anesthesia (NORA) presents a unique opportunity for the application of value-based care (VBC) principles to procedures performed in the office-based and nonoperating room inpatient settings. The purpose of this article is to review how value is defined in NORA and enabling principles by which anesthesiologists can maximize value in NORA.Recent findingsIn order to drive value, NORA providers can target improvements in clinical outcomes where NORA lags behind operating room-based anesthesia (death, over-sedation, nerve injury), implement protocols focusing on intermediate outcomes/quality (postoperative nausea and vomiting, pain control, hypothermia, delirium), incorporate patient-reported outcomes (PROs) to assess the trajectory of a patient's perioperative care, and reduce costs (direct and indirect) through operational and supply-based efficiencies. Establishing a culture of patient and provider safety first, appropriate patient selection with targeted, perioperative optimization of comorbidities, and efficient deployment of staff, space, and resources are critical enablers for success.SummaryValue in NORA can be defined as clinical outcomes, quality, patient-reported outcomes, and efficiency divided by the direct and indirect costs for achieving those outcomes. We present a novel framework adapting current VBC practices in operating room anesthesia to the NORA environment.

Original languageEnglish
Pages (from-to)508-513
Number of pages6
JournalCurrent Opinion in Anaesthesiology
Issue number4
StatePublished - 1 Aug 2022


  • direct cost
  • indirect cost
  • nonoperating room anesthesia
  • patient-reported outcomes
  • time-driven activity-based costing
  • value-based care


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