NAP4 Methods and Census Results

2. NAP4 Methods and Census Results Dr Nick Woodall NAP4 Wednesday July 13th 2011

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

5. Major Complications of Airway Management Death Brain damage Emergency surgical airway ICU admission

6. Major Complications of Airway Management Death Brain damage Emergency surgical airway ICU admission or increased length of stay

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

8. Incidence 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 Number of complications _________________________________________________________________________________ Number of Airway Interventions

9. NAP4 2 Phases 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 Number of complications _________________________________________________________________________________ Number of Airway Interventions

10. Incidence 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 Number of complications _________________________________________________________________________________ Number of Airway Interventions

11. Organisation • Multispecialty planning group • Local reporters recruited • Census of current activity • Secure web-site on-line case submission • Case review panel

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

14. 100% of hospitals returned data Census

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

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

22. Incidence Number of complications _________________________________________________________________________________ 2,900,000

23. Incidence Case submission Study of complications Over one year 01/09/2008 - 31/08/2009 Provides numerator Number of complications _________________________________________________________________________________ 2,900,000

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