An observational national study of anaesthetic workload and seniority across the working week and weekend in the UK in 2016: the 6th National Audit Project (NAP6) Activity Survey

H Kemp; S Marinho; T M Cook; L Farmer; M Bellamy; W Egner; S Farooque; K Ferguson; K Floss; T Garcez; S Karanam; J Hitchman; K-L Kong; N McGuire; S Nasser; D N Lucas; M Thomas; H Torevell; A Warner; N J N Harper

doi:10.1016/j.bja.2018.04.010

An observational national study of anaesthetic workload and seniority across the working week and weekend in the UK in 2016: the 6th National Audit Project (NAP6) Activity Survey

Br J Anaesth. 2018 Jul;121(1):134-145. doi: 10.1016/j.bja.2018.04.010. Epub 2018 May 21.

Authors

H Kemp¹, S Marinho², T M Cook³, L Farmer⁴, M Bellamy⁵, W Egner⁶, S Farooque⁷, K Ferguson⁸, K Floss⁹, T Garcez¹⁰, S Karanam¹¹, J Hitchman¹², K-L Kong¹², N McGuire¹³, S Nasser¹⁴, D N Lucas¹⁵, M Thomas¹⁶, H Torevell, A Warner¹⁷, N J N Harper¹⁸

Affiliations

¹ Imperial College London, UK (Research and Audit Federation of Trainees).
² Manchester University NHS Foundation Trust, Manchester, UK (British Society of Allergy and Clinical Immunology).
³ Royal United Hospital, Bath, UK; University of Bristol School of Medicine, Bristol, UK; Royal College of Anaesthetists, London, UK. Electronic address: [email protected].
⁴ Royal College of Anaesthetists, London, UK.
⁵ Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds University, Leeds, UK (Faculty of Intensive Care Medicine).
⁶ Sheffield Teaching Hospitals NHS Trust, Sheffield, UK; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK (Royal College of Physicians/Royal College of Pathologists Joint Committee on Immunology and Allergy).
⁷ Imperial College Healthcare NHS Trust, London, UK.
⁸ Aberdeen Royal Infirmary, Aberdeen, UK (Association of Anaesthetists of Great Britain and Ireland).
⁹ Oxford University Hospitals NHS Trust, Oxford, UK (Royal Pharmaceutical Society of Great Britain).
¹⁰ Manchester University NHS Foundation Trust, Manchester, UK (United Kingdom Fatal Anaphylaxis Register).
¹¹ Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹² Sandwell and West Birmingham NHS Trust, Birmingham, UK.
¹³ Medicines and Healthcare products Regulatory Agency, London, UK.
¹⁴ Cambridge University Hospitals NHS Foundation Trust, Cambrifge, UK (British Society for Allergy and Clinical Immunology).
¹⁵ Northwick Park Hospital, Harrow, UK (Obstetric Anaesthetists Association).
¹⁶ Great Ormond Street Hospital, London, UK (Association of Paediatric Anaesthetists of Great Britain and Ireland).
¹⁷ Allergy UK, London, UK.
¹⁸ Leeds Teaching Hospitals NHS Trust, Leeds, UK; Manchester University NHS Foundation Trust, Manchester, UK (British Society of Allergy and Clinical Immunology); Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK.

PMID: 29935565
DOI: 10.1016/j.bja.2018.04.010

Abstract

Background: UK national anaesthetic activity was studied in 2013 but weekend working was not examined. Understanding changes since 2013 in workload and manpower distribution, including weekends, would be of value in workforce planning.

Methods: We performed an observational survey of NHS hospitals' anaesthetic practice in October 2016 as part of the 6th National Audit Project of the Royal College of Anaesthetists (NAP6). All cases cared for by an anaesthetist during the study period were included. Patient characteristics and details of anaesthetic conduct were collected by local anaesthetists.

Results: Responses were received from 342/356 (96%) hospitals. In total, 15 942 cases were reported, equating to an annual anaesthetic workload of ≈3.13 million cases. Approximately 95% (9888/10 452) of elective and 72% (3184/4392) of emergency work was performed on weekdays and 89% (14 145/15 942) of activity was led by senior (consultant or career grade) anaesthetists and 1.1% (180/15942) by those with <2 yr anaesthetic experience. During weekends case urgency increased, the proportion of healthy patients reduced and case mix changed. Cases led by senior anaesthetists fell to 80% (947/1177) on Saturday and 66% (342/791) on Sunday. Senior involvement in obstetric anaesthetic activity was 69% (628/911) during the week and 45% (182/402) at weekends, compared with 93% (791/847) in emergency orthopaedic procedures during the week and 89% (285/321) at weekends. Since 2013, the proportion of obese patients, elective weekend working, and depth of anaesthesia monitoring has increased [12% (1464/12 213) vs 2.8%], but neuromuscular monitoring has not [37% (2032/5532) vs 38% of paralysed cases].

Conclusions: Senior clinicians deliver most UK anaesthesia care, including at weekends. Our findings are important for any planned workforce reorganisation to rationalise 7-day working.

Keywords: anaesthesia; audit; monitoring; technique; workforce.

Publication types

Observational Study

MeSH terms

Adult
Anesthesia, Obstetrical / statistics & numerical data
Anesthesiologists*
Anesthetics
Consciousness Monitors
Cross-Sectional Studies
Emergency Medical Services
Female
Humans
Male
Medical Audit*
Monitoring, Intraoperative / statistics & numerical data
Neuromuscular Monitoring
Obesity / complications
Pregnancy
Surveys and Questionnaires
United Kingdom
Workload / statistics & numerical data*

Substances

Anesthetics