2. 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

3. Outline
Aims
Organisation of the project
Census
Census results

4. 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

5. 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

6. 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

7. 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

8. 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/ /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

9. 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/ /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. 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/ /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

11. 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

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

13. 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

14. 100% of hospitals returned data
Census
100% of hospitals returned data

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

16. Census

17. 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

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

19. Created a new column

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

21. 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

22. 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

23. Number of complications
Incidence
Case submission
Study of complications
Over one year
01/09/ /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

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

25. 12,600 Anaesthetists 2007

26. 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

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

28. The End