Episode #311 From Cable Chaos To One Step Airway Access

Opening Clip: [John Edwards] “I spent a day on the non-operating room anesthesia orientation track, and we were assigned to the neurointerventional radiology suite. When I was down there, I realized that the layout and the setup of the room was very challenging. There were cables everywhere. We had a very large anesthesia machine that wasn’t positioned well. The neurointerventional radiology team had monitors and cables all in the access area that we needed to get to our patient, and I found that we just had a very small footprint. When I questioned my colleague about the layout of that room, he stated that this is how it had been since they opened and that we just needed to get used to the space.”

[Bechtel] Are there any spaces that you have told to just get used to while you are providing anesthesia care? There may be significant safety hazards in non-operating room anesthesia spaces from tripping hazards from cables or obstructed access to the patient or physical trauma from large screens and equipment in a small space without a lot of room to maneuver.

Hello and welcome back to the Anesthesia Patient Safety Podcast. I’m your host, Alli Bechtel. Today, we are turning our attention to a 2-025 quality improvement project at the University of Kentucky Medical Center that involved a redesign of the neuro-Interventional Radiology anesthesia workspace to address safety hazards. This project is a great example of using evidence-based interventions for improving safety and efficiency in non-operating room anesthesia locations.

Before we dive further into the episode today, we’d like to recognize Blink Device Company, a major corporate supporter of APSF. Blink Device Company has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Blink Device Company – we wouldn’t be able to do all that we do without you!”

Our featured article is “Non-Operating Room Anesthesia (NORA) Safety: Redesigning the Neurointerventional Radiology Suite” by John Edwards and colleagues. This is a APSF Newsletter Article that was published online April 24, 2026. To follow along with us, head over to APSF.org and click on the Newsletter Heading. The first one down is Newsletter articles. Then, you can scroll down until you get to our featured article, and I will include a link in the show notes as well.

Before we get into the article, here is a brief note from the Editors: “The quality improvement projected presented here reflects the experiences and practices at the authors’ institutions. It is not prescriptive and offers valuable insight and potential frameworks for improving patient safety. We encourage readers and listeners of this podcast to use these examples as a starting point and then make any necessary adaptations within your own clinical settings.

To help kick off the show today, we are going to hear from the Author. I will let him introduce himself now.

[John Edwards] “  My name is John Edwards. I’m a certified registered nurse anesthetist at the University of Kentucky in Lexington, Kentucky

[Bechtel] I asked John what got him interested in this topic. Let’s take a listen to what he had to say.

[John Edwards] “When I joined the team at the University of Kentucky in the Department of Anesthesia a couple of years ago, we had a very thorough orientation process, and I spent a day on the non-operating room anesthesia orientation track, and we were assigned to the neurointerventional radiology suite. When I was down there, I realized that the layout and the setup of the room was very challenging. There were cables everywhere. We had a very large anesthesia machine that wasn’t positioned well. The neurointerventional radiology team had monitors and cables all in the access area that we needed to get to our patient, and I found that we just had a very small footprint. When I questioned my colleague about the layout of that room, he stated that this is how it had been since they opened and that we just needed to get used to the space. Then I began to talk to colleagues in the hallways and the break rooms about the neurointerventional radiology suite and found that people did not enjoy working down there, that they felt the same way I did, that the layout was challenging And it was a difficult space to spend your day. So I decided, why don’t we do something about it? And that’s where this topic came from.”

Thank you to John for introducing this topic. Now, it’s time to get into the article. If patient safety is the priority, then the goal in any Non-operating anesthesia space is an organized, hazard-free workspace with unobstructed access to the patient. This is the call to action from the APSF. The American Society of Anesthesiologists agrees in their 2023 updated Statement on Non-Operating Room Anesthesia Services. In this statement, there is a requirement for “Sufficient space to accommodate necessary equipment and personnel and to allow expeditious access to the patient, anesthesia machine (when present) and monitoring equipment.” I will include the link to the complete statement in the show notes as well.

Let’s chat about the quality improvement project at the University of Kentucky Medical Centre by the Department of Anesthesiology, Perioperative, Critical Care, and Pain Medicine to re-design the neuro-interventional radiology anesthesiology workspace. This was a process improvement project that was exempt from review by Institutional Review Board. The goal of the project was to expand the space, streamline equipment, and remove clutter leading to a safer, more efficient environment. We are going to cover the approach, key outcomes, and lessons learned. This can be really helpful for any anaesthesiology professionals working in restricted NORA spaces.

The first step was a targeted survey of anesthesia professionals in the anesthesia department using the UK Department of Anesthesiology Provider Satisfaction with Unit Design Questionnaire. You can check this out in Figure 1 in the article and in the show notes. This tool used quantitative ratings on a 1-5 Likert scale focusing on safety and functionality during induction, maintenance, and emergence from anesthesia, capturing qualitative insights as well. Here are some of the results prior to the intervention.

88% of respondents reported barriers to optimal patient care.

86% were dissatisfied with their ability to provide care without harming themselves during procedures.

Optimal patient care involves safe and timely access to the patient including airway and vascular access sites.

96% of respondents recognized the need for layout changes

Additional results from the qualitative feedback included some of the following statement that highlight the safety challenges in this NORA space:

• “Issues of frequently bumping into the monitor when providing care and having consistent availability of mobile lead shields. Having to crouch a lot to draw blood gases, check lines, etc…difficult ergonomics for body positions while doing procedures.”
• “One should not have to straddle a C-arm to reach the bag to ventilate a patient while simultaneously craning one’s neck to see the monitor.”
• “Navigating the equipment is unsafe to the cranium, the spine, and personal morale. There is no greater place for injuring anesthesia personnel.”
• “Very challenging to give superior care to patients with such a cramped and nonsensical layout.”
• “Many times, the IR monitor is in the direct walking path of the anesthesia professional. I must crawl to get to the arterial line transducer, patient, and other important items….inducing anesthesia alone is difficult.”

The next step was using the recommendations from the literature to engage in a collaborative re-design of the space. Adequate space defined by the ASA is a recommendation for a minimum of 85 square feet with unimpeded access to the patient. The multidisciplinary team included anesthesia staff, interventional radiologists, NORA personnel, and facility managers. Some of the important topics of conversation during this time included low-disruption interventions like replacing an oversized anesthesia machine with a more compact model, using a pre-existing ceiling-mounted boom for cable management, and repositioning equipment to optimize the anesthesia workspace. Just from these changes, the workspace grew from only 14 square feet to 85 square feet which meant that more team members and necessary equipment could fit in the space without further crowding. To see what this looked like, check out Figures 2 and 3 in the article and the difference is impressive. Successful projects require buy-in from team members. For this project, the team incorporated hands-on staff training sessions, proactively addressed resistance by demonstrating benefits such as more efficiency with arterial line placement and decreased physical strain on anesthesia professionals.

So, what were the results of this re-design? Post-implementation feedback revealed the following changes:

Improved ability to move and operate in the suite. It used to take up to 22 steps to navigate around the equipment to access the patient’s airway and this distance was reduced to a single step! This is a significant improvement that allowed the anesthesia professionals to perform their job and provide safe anesthesia care. Improved anesthesia care involved assess to the patient and the ability to manage the patient’s airway faster and safer without needing a second provider.

In addition, the new layout was a larger space with less clutter leading to improved efficiency during induction, maintenance, and emergence with improved overall satisfaction.

Thus, the re-designed neuro-interventional anesthesia workspace was safer for both patients and the anesthesia professionals working in the space.

Here are the lessons learned from this project and the big takeaways for a successful redesign.

Early engagement with the frontline anesthesia professionals

Use of existing infrastructure such as the ceiling-mounted boom and compact anesthesia machine helped to minimize costs and avoided interruptions to clinical procedures.

This re-design did not disrupt the scheduling of cases in the neurointerventional radiology suite which allowed continuous patient care.

Collaboration with departmental leadership and facility managers helped the project to align with institutional goals and proceed in a smooth and timely manner.

After the re-design, it is important to track safety incidents in this space and establish regular feedback mechanisms to sustain the improvements and guide future projects.

This projects highlights the vital role of intentional workspace optimization in advancing patient safety as well as anesthesia professional well-being and safety. We hope that if you find yourself in a cramped and cluttered NORA space, you can use this as a blueprint for your own re-design, for your own transformative change in anesthesia care delivery.

Before we wrap up for today, we are going to hear from John again. He shares with us what he hopes to see going forward.

[John Edwards] “So going forward in the non-operating room anesthesia space, I hope to see that we can find ways to improve the anesthesia workflow so that we can improve not only safety, safety for patients, but also safety for our anesthesia professional colleagues. That we would be able to work in a space that we enjoy, that we are able to work without being harmed, and that we would have a high morale, that we would find our days enjoyable in these spaces. So we need to be thoughtful about how we design these spaces going forward.”

Thank you so much to John for contributing to the show today and your work in this challenging non-operating room anesthesia space.

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

Thank you for listening to the Anesthesia Patient Safety Podcast. If you enjoyed this episode, please subscribe, share it with your colleagues, and help us continue the conversation about safer care for every patient, every time. And if you want to learn more about providing safer anesthesia care in Non-Operating Room Anesthesia spaces, head over to APSF.org for articles and podcasts. A good place to start is with the Consensus Recommendations for the Safe Conduct of Nonoperating Room Anesthesia: a Meeting Report from the 2022 Stoelting Conference of the APSF by John Beard and colleagues. You can find the link in the show notes.

Until next time, stay vigilant and stay informed so that no one shall be harmed by anesthesia care.

© 2026, The Anesthesia Patient Safety Foundation