As far as we know, this issue of the Journal marks the first occasion that an article has been published in both Anaesthesia and the British Journal of Anaesthesia as a simultaneous joint publication [1, 2]. We believe that this is in itself significant, representing a spirit of cooperation between two publications that are, let's face it, rivals (albeit friendly ones). More significant, however, is the subject of the article, the 5th National Audit Project (NAP) – a collaboration between the Association of Anaesthetists of Great Britain & Ireland (AAGBI) and the Royal College of Anaesthetists (RCoA). By the unprecedented step of jointly publishing this preliminary baseline survey of awareness in the UK, we hope to emphasise the strength of the cooperation between these two organisations, representing as they do the two main voices of our specialty, and to underline the importance of both the NAP methodology and this complication in our practice.
The NAP programme began within the RCoA, in the form of two audits conducted in 2003: the supervisory role of consultant anaesthetists (NAP1); and the place of mortality and morbidity review meetings (NAP2) (see http://www.rcoa.ac.uk/node/1426). The NAP3 report, into complications of central neuraxial block , and the NAP4 report, into airway complications (with the Difficult Airway Society) , have become major reference works for the incidence and management of these complications in the UK, hugely strengthened by the comprehensive national coverage they achieved. We expect NAP5, into accidental awareness during anaesthesia, to be equally well supported by the profession and equally authoritative and important.
The NAPs’ methods of data collection and interpretation include case studies, audits and service evaluations. Accordingly, data analysis involves a mixture of quantitative, semi-quantitative and qualitative techniques. On the hierarchy of evidence, a ‘purist’ might place the results of the NAPs at only Level 4 (i.e. case studies without controls). However, these projects’ importance lies in their scope and pragmatism. The main criterion for selecting NAP5's topic was the universal nature of the problem. The project has been planned and steered by a multidisciplinary team including anaesthetists, intensivists, psychologists, patient safety experts and lay public members. The underpinning working principles, and the main strengths, of NAP5 are first, coverage of the entire nation and second, data analyses involving a relatively large multidisciplinary team with wide ranging expertise. Like its predecessors, NAP5 hopes to deliver a powerful, far-reaching message by representing pragmatic, real-life situations, and by providing common-sense, workable solutions.
The paper itself [1, 2] concerns the first phase of the project, and presents the results of a nationwide survey of the incidence of awareness of which anaesthetists have become known in the year 2011. In an accompanying editorial (also published in both journals [5, 6]), Avidan and Mashour provide an independent (i.e. not associated with NAP5 or its steering organisations) appraisal of the paper and its significance.
The AAGBI and the RCoA have a lot in common but also a lot that separates them, and our specialty gains enormously from having both organisations. The same could be said for our two journals. We hope that the NAP5 project, and the way it has been organised, administered and (by joint publication) hereby disseminated, demonstrates how all four can work together.