NAP4 Methods and Census Results Dr Nick Woodall NAP4 Wednesday July 13th 2011 Introduction   Thanks for giving me the opportunity to talk about NAP four, This project has been a massive undertaking, And I will be talking on behalf of the whole project It has involved every UK anaesthetist in this room. You have all contributed to the census of airway management activity , you have all funded the project through DAS the RCoa You have contributed data to the snapshot or and most importantly some you have contributed cases. Others have had a more direct organisational role in the project and many you have all made made essential contributions some of us submitted reports the important contribution of those who reported cases to the project as LRs a moderator review panel members. An mosyt of you through DAS the RCoa or a specialist society have made a financial contribution. many DAS members have been central to the planning and organisation of the project 2

Outline Aims Organisation of the project Census Census results

National Audit Project 4 Investigate the major complications of airway management in UK anaesthetic practice Calculate the incidence of serious complications Learn from adverse events and look for themes Firstly every hospital or trust in the United Kingdom has signed up to participate in this project and we have a Local Reporter in every one. 4

Major Complications of Airway Management Death Brain damage Emergency surgical airway ICU admission Firstly every hospital or trust in the United Kingdom has signed up to participate in this project and we have a Local Reporter in every one. 5

Major Complications of Airway Management Death Brain damage Emergency surgical airway ICU admission or increased length of stay Firstly every hospital or trust in the United Kingdom has signed up to participate in this project and we have a Local Reporter in every one. 6

National Audit Project 4 Investigate the major complications of airway management in UK anaesthetic practice Calculate the incidence of serious complications Learn from adverse events and look for themes Firstly every hospital or trust in the United Kingdom has signed up to participate in this project and we have a Local Reporter in every one. 7

Incidence Number of complications Number of Airway Interventions Census A snapshot of practice Over a 2 week period During 2008/2009 Provides denominator Case submission Study of complications Over one year 01/09/2008 - 31/08/2009 Provides numerator In order to determine the incidence we need to know. This could be determined for anaesthesia but not in the ED and ICU environments Number of complications _________________________________________________________________________________ Number of Airway Interventions 8

NAP4 2 Phases Number of complications Number of Airway Interventions Snapshot A snapshot of practice Over a 2 week period During 2008/2009 Provides denominator Case submission Study of complications Over one year 01/09/2008 - 31/08/2009 Provides numerator Phase 2 also started in September, this will be a year-long exercise collecting data on severe complications of airway management. Number of complications _________________________________________________________________________________ Number of Airway Interventions

Incidence Number of complications Number of Airway Interventions Census A snapshot of practice Over a 2 week period During 2008/2009 Provides denominator Case submission Study of complications Over one year 01/09/2008 - 31/08/2009 Provides numerator Phase 2 also started in September, this will be a year-long exercise collecting data on severe complications of airway management. Number of complications _________________________________________________________________________________ Number of Airway Interventions 10

Organisation Multispecialty planning group Local reporters recruited Census of current activity Secure web-site on-line case submission Case review panel Decision taken to look beyound anaesthesia nd investigate ITU and airway management in the ED

Local Reporters Point of contact Disseminated information Co-ordinate data collection

The Census Two week period September 2008-2009 Number of general anaesthetics Airway management of cases under GA The snapshot will collected information on anaesthetic activity in each hospital over the two week period. This process will be co-ordinated by the Local reporter. 13

100% of hospitals returned data Census 100% of hospitals returned data

Census accurate (0-2% error) close estimate (2-10% error) estimate (>10% error) or guess (no data to support the figure)

Census

Census Results Results tested against HES and ONS data Some LRs took drastic action and emigrated to avoid NAP4 This was done last year and we have received returns from over 96% of UK hospitals. Some units had problems collecting data and the process has been repeated this year. We anticipate 100% response. Final figures generated will be cross referenced using the most accurate reports submitted and compared to HOSPITAL Episode Statistics and Office of ONS National Statistics data. 17

I mentioned we would cross reference the snapshot with other sources and study of the HES figures shows a problem

Created a new column

Census accurate (0-2% error) close estimate (2-10% error) estimate (>10% error) or guess (no data to support the figure)

Incidence Number of complications Number of Airway Interventions Phase 2 also started in September, this will be a year-long exercise collecting data on severe complications of airway management. Number of complications _________________________________________________________________________________ Number of Airway Interventions 21

Number of complications Incidence Phase 2 also started in September, this will be a year-long exercise collecting data on severe complications of airway management. Number of complications _________________________________________________________________________________ 2,900,000 22

Number of complications Incidence Case submission Study of complications Over one year 01/09/2008 - 31/08/2009 Provides numerator Phase 2 also started in September, this will be a year-long exercise collecting data on severe complications of airway management. Number of complications _________________________________________________________________________________ 2,900,000 23

Census accurate (0-2% error) close estimate (2-10% error) estimate (>10% error) or guess (no data to support the figure)

12,600 Anaesthetists 2007

General Anaesthetics per WT Anaesthetist 2.9 million general anaesthetics 12,600 anaesthetists 230 GA cases pa 1/3 cases 2 anaesthetists 10% work part-time 360 cases pa WT anaesthetist ICU, pain, hospital management, academic anaesthesia regional anaesthesia

Census Findings 2.9 million general anaesthetics 56% SAD 38% Tracheal tube 5% Facemask 360 GA pa whole-time anaesthetist

The End