SNAP1 (Patient-reported outcomes after anaesthesia)

The first Sprint National Anaesthesia Project (SNAP1) took place on Tuesday 13 May and Wednesday 14 May 2014.

SNAP1 was led by Chief Investigator Professor Ramani Moonesinghe and Trainee Investigator Dr Ellie Walker.

The SNAP1 results were published in the British Journal of Anaesthesia in December 2016.

• Click here to read the SNAP1 results paper
• Click here to read a paper on the design and methodology of SNAP1

SNAP1 was a research project which involved a 2-day evaluation of patient reported outcomes after anaesthesia: specifically, patient satisfaction after anaesthesia and patient-reported awareness.

SNAPs are intended to provide a 'snapshot' evaluation of clinical activity and patient centred outcomes that are important and relevant to both patients and anaesthetists.

SNAP1 was the first in what we hope will be an exciting new initiative of projects involving anaesthetists and hospitals throughout the UK.

Project Outline

SNAP1 aimed to provide a 'snapshot' of clinical activity in hospitals throughout the UK over a 2 day period on Tuesday 13th and Wednesday 14th May 2014. It was a pragmatic evaluation of patient-reported outcomes after anaesthesia; specifically patient satisfaction and patient reported awareness.
Data collection at each site was managed predominantly by anaesthetic trainees (Local Investigators LI), under the supervision of a Local Lead Investigator (LLI). 

Ethical Considerations

SNAP1 was a research project, and as such, has undergone ethical review and received approval from the HRA/NRES Committee of the East Midlands.

We provided the NIHR with a list of each of the sites which registered LLIs. Following this, the R&D department at each Trust was notified and completed their local checks.

Outcome Measures

The specific outcome measures used in SNAP1 were the validated Patient Satisfaction Questionnaire devised by Bauer et al and the Modified Brice Questionnaire which has been adapted from protocol for the BAG-RECALL clinical trial by Avidan et al.

Objectives

This SNAP aimed to establish a national benchmark for patient satisfaction after anaesthesia, which hospitals could then use to evaluate the service that they are delivering to patients and subsequently, if necessary, take action to improve quality.

Secondarily, the intention was to establish an estimate of the incidence of accidental awareness during general anaesthesia in the UK population; this concept of a "Brice day" was part of the activity that was proposed for NAP5.

Inclusion Criteria

All adult (>=18 years) patients, undergoing any type of non-obstetric surgery in an operating theatre, in an NHS hospital in the UK during the study period were eligible to be included. This included both day case and in-patient surgery as well as planned elective cases in addition to urgent or emergency operations. Endoscopic or interventional radiological procedures carried out under GA or sedation given by an anaesthetist were also included.

Exclusion Criteria

Patients <18 years old; those who were unable to understand spoken or written English; obstetric patients; patients who were too unwell or confused to be able to complete the questionnaires or those who declined to participate. Non-surgical interventions such as 'pain procedures', ECT or anaesthetic room procedures (e.g. CVC insertion, LP) were also excluded.

How did the project work?

Under the supervision of the LLI, LIs at each hospital were responsible for the data collection and administration of the two questionnaires to all consenting patients within 24 hours of their operation. 

Each potential participant was provided with a patient information leaflet on admission to hospital, prior to their surgery, so that they had time to consider the information provided. Completion of the questionnaire was taken as implied consent to participate.

The anaesthetist responsible for the care of every patient undergoing surgery on 13th and 14th May was asked to complete a form with basic patient demographic information (e.g. age, type of surgery, type of anaesthesia) during the operation. After completion of the surgery and full recovery from anaesthesia, patients were approached by LIs or nominated representatives to complete the two paper-based questionnaires. Patients undergoing day-case procedures were asked to complete the questionnaires before they were discharged home on the day of their surgery and those who remained as in-patients in hospital were approached within 24 hours of their operation once they were on a ward. 

Each registered investigator then input data from these forms to a secure data collection webtool. Following this, the anonymised responses from hospitals across the UK were analysed by a team of researchers based at the UCL/UCLH Surgical Outcomes Research Centre in London.

If you have any questions regarding SNAP1, please email snap@rcoa.ac.uk