#311 From Cable Chaos To One Step Airway Access

Twenty-two steps to reach an airway is not a quirky workflow problem, it’s a patient safety problem. We’re turning our attention to a neuro-interventional radiology (Neuro IR) suite where cables, monitors, and a poorly positioned anesthesia machine created a cramped, high-friction non-operating room anesthesia (NORA) environment. Joined by John Edwards, CRNA, we unpack how a real-world quality improvement project at the University of Kentucky Medical Center turned staff frustration into an evidence-based anesthesia workspace redesign.

We start with what triggered the change: frontline clinicians describing barriers to optimal patient care, unsafe ergonomics, and a layout that made simple tasks unnecessarily hard. From there, we connect the dots to broader NORA safety expectations, including the American Society of Anesthesiologists guidance on having sufficient space, equipment access, and the ability to reach the patient quickly. Them, the team brings anesthesia staff, interventional radiology personnel, and facilities managers together to redesign the room with minimal disruption.

You’ll hear the practical interventions that made the difference, like cable management using existing ceiling infrastructure, switching to a more compact anesthesia machine, and repositioning equipment to restore clear access to the patient. The results are striking: smoother movement, less clutter, improved morale, and a dramatic reduction in the distance to the airway. If you work in any NORA location, this is a blueprint for safer anesthesia workflows.

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For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/311-from-cable-chaos-to-one-step-airway-access/

© 2026, The Anesthesia Patient Safety Foundation

Transcript

A Cramped Suite Sparks Change

SPEAKER_00 0:00

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 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.

Why NORA Layout Drives Safety

Alli 1:12

Today we are turning our attention to a 2025 quality improvement project at the University of Kentucky Medical Center that involved a redesign of the Neurointerventional 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 an APSF newsletter article that was published online April 24th, 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 project presented here reflects the experiences and practices at the author's institution. 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 setting. And to help kick off the show today, we are going to hear from the author. I will let him introduce himself now.

SPEAKER_00 3:11

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

Alli 3:18

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

SPEAKER_00 3:24

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 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 that it was a difficult space to spend your day. So I decided, why don't we do something about it?

Alli 4:32

Thank you to John for helping to introduce this topic. And now it's time to get into the article. If patient safety is the priority, then the goal in any non-operating room 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. Now let's chat about the quality improvement project at the University of Kentucky Medical Center by the Department of Anesthesiology, Perioperative, Critical Care, and Pain Medicine to redesign the Neurointerventional Radiology Anesthesiology Workspace. This was a process improvement project that was exempt from review by the 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 anesthesiology professionals working in restricted NORA spaces.

Survey Data Reveals Hidden Hazards

Alli 6:01

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 to 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 the procedure. Optimal patient care involves safe and timely access to the patient, including airway and vascular access sites. And 96% of respondents recognized the need for layout changes. Additional results from the qualitative feedback included some of the following statements that highlight the safety challenges in this NORAS phase. 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 professionals. 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.

Multidisciplinary Redesign On A Budget

Alli 8:03

Now the next step in this project was using the recommendations from the literature to engage in a collaborative redesign 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, neuropersonnel, 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 the 85 square feet that was recommended, 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 two and three 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 the benefits such as more efficiency with arterial line placement, and decreased physical strain on anesthesia professionals. So, what were the results of this redesign?

Results That Make Care Faster

Alli 9:30

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 access to the patient and the ability to manage the patient's airway faster and safer without needing help from 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 redesigned neurointerventional 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 frontline anesthesia professionals, use of existing infrastructure such as ceiling-mounted booms and compact anesthesia machines helped to minimize costs and avoid disruptions to clinical procedures. This redesign did not disrupt the scheduling of cases in the neurointerventional radiology suite, which allowed continuous patient care. Collaboration with department leadership and facility managers helped the project to align with institutional goals and proceed in a smooth and timely manner. And after the redesign, it is important to track safety incidents in the space and establish regular feedback mechanisms to sustain the improvements and guide future projects. This project 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, that you can use this as a blueprint for your own redesign, for your own transformative change in anesthesia care delivery.

Lessons Learned And What’s Next

Alli 11:35

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

SPEAKER_00 11:42

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 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.

Resources, Contact, And Closing

Alli 12:16

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 podcast at apf.org. 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'll 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 Non-Operating Room Anesthesia, a meeting report from the 2022 Stolting Conference of the APSF by John Beard and colleagues. And you can find a link in the show notes as well. Until next time, stay vigilant and stay informed so that no one shall be harmed by anesthesia care.