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Offsite anesthesiology: the challenge of seamless integration with nonanesthesiologist delivered sedation/analgesia.

Modern medical practice continues to be associated with an ever increasing number of diagnostic and therapeutic procedures that, although not performed in the operating room, still benefit from various levels of sedation and analgesia. The number of such procedures that require deep levels of sedation/analgesia or anesthesia is outpacing the capacity of the anesthesiology workforce to meet this clinical need. Our own institution, a mid-sized, about 400-bed academic medical center, has experienced steady growth in offsite delivery of anesthesia. This year the percentage of total was 25% [1]. Although the total number of cases has increased by 30% during the past year, we remain unable to meet all of the demand because of staffing limitations (Fig. 1).