title: The state of UK anaesthesia: a survey of National Health Service activity in 2013.
abstract: BACKGROUND
  Details of current UK anaesthetic practice are unknown and were needed for interpretation of reports of accidental awareness during general anaesthesia (GA) within the 5th National Audit Project.
  
  
  METHODS
  We surveyed NHS anaesthetic activity to determine numbers of patients managed by anaesthetists and details of 'who, when, what, and where': activity included GA, local anaesthesia, sedation, or patients managed awake. Anaesthetists in NHS hospitals collected data on all patients for 2 days. Scaling enabled estimation of annual activity.
  
  
  RESULTS
  Hospital response rate was 100% with 20,400 returns. The median return rate within departments was 98% (inter-quartile range 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 career grade anaesthetist was present in more than 87% 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 anaesthetized 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 anaesthetized. Nine patients out of 15 460 receiving GA died intraoperatively.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK Portex Unit of Anaesthesia, Institute of Child Health, University College London, London WC1N 1EH, UK.
authors.forename: M R J
authors.initials: MR
authors.lastname: Sury
authors.affiliation: Salford Royal Hospital, Salford M6 8HD, UK.
authors.forename: J H M G
authors.initials: JH
authors.lastname: Palmer
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK National Audit Projects, Royal College of Anaesthetists, UK timcook007@gmail.com.
authors.forename: T M
authors.initials: TM
authors.lastname: Cook
authors.affiliation: Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: Pandit
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000706:statistics & numerical data / Q000639:trends*; D000762:Anesthesia Recovery Period; D000765:Anesthesia, Conduction; D000776:Anesthesiology / Q000639:trends*; D000777:Anesthetics; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000706:statistics & numerical data; D056805:Consciousness Monitors; D003253:Consultants; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data / Q000639:trends; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D008991:Monitoring, Physiologic; D010343:Patient Admission; D059035:Perioperative Period / Q000401:mortality; D011247:Pregnancy; D013038:Specialization; D013222:State Medicine; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000777:Anesthetics
keywords: airway; anaesthesia; audit; level of consciousness; monitoring; sedation; technique