National Audit Projects
The National Audit Projects (colloquially known as 'the NAPs') have been running for several years and now have their own website:
The HSRC and NAPs
NAPs 1-4 were supported and managed by the Professional Standards Department of the Royal College of Anaesthetists (RCoA). In 2011 the Health Services Research Centre of the National Institute for Academic anaesthesia (HSRC) was launched with the aim of being a hub for world-class anaesthetic research (including peri-operative medicine, pain and anaesthetic sub-specialties). The responsibility for management of the NAPs has been transferred to the HSRC with oversight by the College council. Dr Tim Cook has a role as a co-ordinating lead (as opposed to project-lead) of the NAPs.
NAP3 and NAP4 as a model for future NAPs
NAP3 and NAP4 examined infrequent events (NAP3- permanent harm caused by neuraxial anaesthesia, NAP4- major complications of airway management in anaesthesia, emergency departments and intensive care) and attempted to determine an incidence of such events. The projects produced censuses of clinical activity relevant to the project topic and a full report of the project findings. Both projects, in addition to refining quantitative aspects of these problems, also collected a large number of in depth case histories which were examined in depth to identify qualitative learning from such rare complications. The final reports were therefore both quantitative and qualitative in nature. Another achievement of both projects has been to focus the attention of the profession (including specialties outside anaesthesia) on the problems under examination: in effect to 'shine a light' on the problem. Both projects have led to changes in practice and likely contributed to improved care in the areas studied.
A model similar to those used for NAP3 and NAP4 appears logical for subsequent NAPs and is likely to focus on a rare complication. For the chosen topic this involves first determining a denominator, if not already known, and then identifying and reviewing a cohort of index events to determine a numerator. NAP3 reviewed 90 events in one year and included 30 in (pessimistic) incidence calculations. NAP4 identified 280 events in one year and included 186 in final analyses. Events that occur either too rarely or too frequently may be difficult to study and NAP3 and NAP4 perhaps represent useful indicative limits of what is both informative and manageable. Other methodologies might be suitable for NAP5 and will not be excluded from future projects.
Another important aspect of the NAPs has been bi-partite partnerships central to their conduct. For NAP3 the College was joined by NCAPCIA of the British Pain Society and for NAP4 the Difficult Airway Society. While many other partner organisations contributed significantly to both projects such partnerships have an important role with NAP-leads from both organisations working together to steer the project in the right direction.