NAP7 Activity Survey

For grade of surgery, how should an angiogram, PCI or TAVI or other interventional cathlab procedures be graded?
We feel probably a TAVI is similar in complexity to an EVAR which is major complex.

For PCI the best comparison is say angiography of iliac vessels +/- stent is 'major' according to SORT so it may be best to put major but we can see it could be intermediate, particularly if just diagnostic...

Having said that we appreciate that there is considerable subjectivity and not all anaesthetists are familiar with this grading so have left if relatively undefined. If you feel not easy to say a grade N/A is appropriate also.

In my hospital anaesthetists insert PICC lines in theatre area: anaesthesia room, OR or recovery. Should the activity survey be completed for these?
Yes please include if these are done in theatre by anaesthetists.

We are seeing a 502 error at the end of the survey and the details are not uploading.
Refreshing the page should do the trick, otherwise please try a different browser and/or check with local IT whether they block survey monkey.

Is there any way the co-ordinator can check which survey entries have been done/not done?
Due to the anonymous reporting to the online survey there is no way to check which cases have been submitted and which haven't. You will need to liaise with your colleagues to find out which cases have been submitted. We have created a tracking sheet that you can adapt to help in tracking your cases:  Activity Survey Tracking Sheet (325 KB)

One of our survey dates is a CME/clinical governance day and there will be limited activity in theatres. Should we change our survey dates to days of full activity?
We understand that there will be some sites where this is the case. Please keep your survey dates as they are as this represents a normal variation.

Should we include Hickman line insertions which are performed by some anaesthetists in my hospital. The patients are awake during the procedure.
Yes please include as it is a 'procedure under the care of an anaesthetist' if you can.

We've missed the start date but would still like to take part in the Activity Survey. Can we still take part?
Please contact nap@rcoa.ac.uk where we can discuss options for running the activity survey in your hospital.

I am not sure how question 45 (neurological complications) should be answered in patients who at the end of the procedure remain anaesthetised and transferred to intensive care unit. The presence of stroke in these patients will not be apparent until they are waken up, potentially after a significant length of time.
You are correct - you may not know if a patient has had a stroke and this may only become apparent later. Only tick if you think it is very likely to have occurred during anaesthesia. Some complications are obvious, e.g a high block, but others may not be. It may be that some such as stroke do not work well as options for the GA patients but we felt this was important enough to include as an option.

We are really interested in complications that have occurred, or highly likely to have occurred, during anaesthesia. It may be that some are highly linked with progression to cardiac arrest, whilst others as less so.

Are Remifentanil PCAs for labour to be included in the activity survey?
Yes if possible please do... enter under case specialty 'obstetrics:labour analgesia'. We will be able to pick them out as you will select intravenous analgesia rather than epidural as an anaesthetic technique during the survey (Q22 in the paper version).

The form isn't working well for epidural analgesia.
It asks for:
- grade of surgery Q16
- ecg, bp pulse etc Q40
I suspect you are entering a labour epidural under case type 'obstetrics: labour analgesia'? If so please select 'minor' for grade of surgery and 'yes' for monitoring.

We will add N/A options to these shortly. We will be able filter the labour epidurals within the survey and set them all to procedure type and monitoring to recovery as N/A.

Are vascular access procedures (peripheral cannulae/ midlines / central lines) and lumbar punctures to be included in the activity survey.
These would only be included if the patient was coming to theatre or recovery to have the procedure done. A CVC or LP in theatre would count as a procedure. I.v. access on the wards, particularly peripheral cannulas don't need to be included.