title: Design and methodology of SNAP-1: a Sprint National Anaesthesia Project to measure patient reported outcome after anaesthesia.
abstract: BACKGROUND
  Patient satisfaction is an important metric of health-care quality. Accidental awareness under general anaesthesia (AAGA) is a serious complication of anaesthesia care which may go unrecognised in the immediate perioperative period but leads to long-term psychological harm for affected patients. The SNAP-1 study aimed to measure patient satisfaction with anaesthesia care and the incidence of AAGA, reported on direct questioning within 24 h of surgery, in a large multicentre cohort. A secondary aim of SNAP-1 was to test the effectiveness of a new network of Quality Audit and Research Coordinators in NHS anaesthetic departments, to achieve widespread study participation and high patient recruitment rates. This manuscript describes the study methodology.
  
  
  METHODS
  SNAP-1 was a prospective observational cohort study. The study protocol was approved by the National Research Ethics Service. All UK NHS hospitals with anaesthetic departments were invited to participate. Adult patients undergoing any type of non-obstetric surgery were recruited in participating hospitals on 13th and 14th May 2014. Demographic data were collected by anaesthetists providing perioperative care. Patients were then approached within 24 h of surgery to complete two questionnaires-the Bauer patient satisfaction questionnaire (to measure patient reported outcome) and the modified Brice questionnaire (to detect possible accidental awareness). Completion of postoperative questionnaires was taken as evidence of implied consent. Results were recorded on a standard patient case report form, and local investigators entered anonymised data into an electronic database for later analysis by the core research team.
  
  
  RESULTS
  Preliminary analyses indicate that over 15,000 patients were recruited across the UK, making SNAP-1 the largest NIHR portfolio-adopted study in anaesthesia to date. Both descriptive and analytic epidemiological analyses will be used to answer specific questions about the patient perception of anaesthesia care overall and in surgical sub-specialties and to determine the incidence of AAGA.
  
  
  CONCLUSIONS
  The SNAP-1 study recruited a large number of UK hospitals and thousands of perioperative patients using newly established networks in the UK anaesthetic profession. The results will provide benchmarking information to aid interpretation of patient satisfaction data and also determine the incidence of AAGA reported on a single postoperative visit.
authors.affiliation: UCL/UCLH Surgical Outcomes Research Centre, University College Hospital NIHR Biomedical Research Centre, London, NW1 2BU UK ; National Institute for Academic Anaesthesia's Health Services Research Centre, Royal College of Anaesthetists, Churchill House 35 Red Lion Square, London, WC1R 4SG UK.
authors.forename: Suneetha Ramani
authors.initials: SR
authors.lastname: Moonesinghe
authors.affiliation: UCL/UCLH Surgical Outcomes Research Centre, University College Hospital NIHR Biomedical Research Centre, London, NW1 2BU UK ; National Institute for Academic Anaesthesia's Health Services Research Centre, Royal College of Anaesthetists, Churchill House 35 Red Lion Square, London, WC1R 4SG UK.
authors.forename: Eleanor Mary Kate
authors.initials: EM
authors.lastname: Walker
authors.affiliation: National Institute for Academic Anaesthesia's Health Services Research Centre, Royal College of Anaesthetists, Churchill House 35 Red Lion Square, London, WC1R 4SG UK.
authors.forename: Madeline
authors.initials: M
authors.lastname: Bell
keywords: Anesthesia awareness; Cohort study; Epidemiology; Patient satisfaction; Patient-reported outcome