Nationwide survey of all UK hospitals shows anaesthetic care is consultant delivered and very safe

The Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) have completed a comprehensive survey of UK anaesthetic activity which is published in the British Journal of Anaesthesia today. The study demonstrates high levels of consultant-delivered care throughout the week and exemplary standards of safety.

The study is the most detailed and complete survey ever performed of a nation’s anaesthetic activity. With a 98% return rate and with data from all UK NHS hospitals it captures detailed information on anaesthesia for 20,400 cases, and provides a wealth of information about current anaesthetic processes and techniques.

The survey, which was completed by anaesthetists in every NHS hospital in the UK, demonstrates that anaesthetists are responsible for the care of more than 3.5 million patients per year. This means that in a given year 1 in 20 of the population will require an anaesthetic.
The study reveals that three quarters of patients undergo general anaesthesia whilst the other quarter have their procedure either awake or sedated. Almost a quarter of procedures are emergencies. 

The study demonstrates that anaesthesia is a consultant-led service with senior doctors present for 87% of all anaesthetics and for three quarters of those administered “out of hours”. In those patients requiring immediate surgery, the study identified areas where delivery of anaesthesia by senior staff could be further improved.

The 15,460 survey returns after general anaesthesia recorded just nine deaths during the time the patient was under the care of the anaesthetist – a mortality rate of 0.06% or 1 in 1700. Most of the patients who died were elderly, infirm and undergoing emergency surgery.

Dr Mike Sury, Consultant Anaesthetist at Great Ormond Street and lead author stated: “The findings contrast interestingly with other studies that have looked at mortality after surgery throughout a hospital stay, such as the European Surgical Outcomes Trial (EuSOS) which reported a 3.6% (1 in 28) mortality. The current survey covers a broader group of patients, but for a shorter period of time, and the mortality is notably lower.” 

Professor Jaideep Pandit, Consultant Anaesthetist in Oxford and Project Lead stated: “The high rates of senior doctor presence throughout the week show that anaesthetists are already embracing seven-day working. In addition the results clearly show the extent of service change that will be required for elective seven-day working to become the norm.”

Professor Tim Cook, Consultant Anaesthetist in Bath, Advisor to National Audit Projects and co-author of the report, commented:“The low mortality rate for patients under the direct care of an anaesthetist demonstrates a high level of safety in modern anaesthesia delivered by trained doctors. This should be very reassuring for patients. However, we know that hospital mortality rates for high risk patients are perhaps 50 times higher and this study suggests that factors occurring after surgery and anaesthesia are important in those higher mortality rates. This is an area where future research should be directed.”

According to RCoA President, JP van Besouw and AAGBI President, William Harrop-Griffiths, both organisations see patient safety as their number one priority:  “The low mortality figures reflect a huge body of work by the Association, College and their members in developing safety initiatives to support the specialty, including: Safe Anaesthesia Liaison Group, Patient Safety Alerts, Risk leaflets, Standards of Clinical Practice and National Audit Projects. The figure of 3.5 million patients anaesthetised per year reflects the considerable workload undertaken by anaesthetists working within the NHS.”

Conducted in 2013, the survey forms part of 5th National Audit Project (NAP5). NAP5 studies accidental awareness during anaesthesia (AAGA) and will be published on 10 September 2014.

07 August 2014