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CHAPTER
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229
NAP5
Report and findings of the 5th National Audit Project
Jaideep J Pandit
Tim M Cook
James H MacG Palmer
Michael R J Sury
HEADLINE
27.1 Details of current UK anaesthetic practice are unknown, and were needed for interpretation of reports of
accidental awareness during general anaesthesia (AAGA) within NAP5. We surveyed NHS anaesthetic activity to
determine numbers of patients managed by anaesthetists and details of ‘who, when, what and where’: activity
included general anaesthesia, local anaesthesia, sedation or patients managed fully awake. Anaesthetists in NHS
hospitals collected data on all patients for two days. Scaling enabled estimation of annual activity. Response rate
was 100% with 20,400 returns. The median hospital return rate was 98% (IQR 0.95
–1). Annual numbers (% of
total) of general anaesthetics, sedation and awake cases were 2,766,600 (76.9 %), 308,800 (8.6 %) and 523,100
(14.5%) respectively. A consultant or a career grade anaesthetist was present in over 86% of cases. Emergency
cases accounted for 23.1% of workload, 75% of which were undertaken out of hours. Specialties with the largest
workload were orthopaedics/trauma (22.1%), general surgery (16.1%) and gynaecology (9.6%): 6.2% of cases
were non-surgical. The survey data describe: who anaesthetised patients according to time of day, urgency and
ASA grade; when anaesthesia took place by day and by weekday; the distribution of patient types, techniques
and monitoring where patients were anaesthetised. Nine patients out of 15,460 receiving general anaesthesia
died during the procedure. Anaesthesia in the UK is currently predominantly a consultant-delivered service. The
low mortality rate supports the safety of UK anaesthetic care. The survey data should be valuable for planning and
monitoring anaesthesia services.
The NAP5 Activity Survey
CHAPTER
27
BACKGROUND
27. 2 The main focus of the NAP5 project was the
collection of new patient reports of AAGA over
one year in the UK, and separately in Ireland. This
registry provides a numerator. In order to estimate
the incidence of reports of AAGA, the denominator
number of general anaesthetics administered was
needed. Moreover, to best interpret the AAGA
reports an analysis of current anaesthetic practices
was required.
27.3 There are several potentially useful estimates of
anaesthesia-related activity available. In England
and Wales, national data are collected by Hospital
This chapter is reproduced, in part, as a summary
paper and should be quoted or referred to as: Sury
MRJ, Palmer JHMacG, Cook TM, Pandit JJ. The state
of UK anaesthesia: a survey of National Health Service
activity in 2013. British Journal of Anaesthesia 2014
doi: 10.1093/bja/aeu292. All gures in that paper are
reproduced with permission of the Editor-in-Chief of
the British Journal of Anaesthesia, Oxford University
Press.