Faculty statement regarding SNAP2 publication

7 September 2018

The Faculty welcomes the first publication arising from the work of the 2nd Sprint National Anaesthesia Project: Epidemiology of Critical Care provision after Surgery (SNAP-2: EpiCCS).This BJA article concentrates on risk factors for cancellation of major surgery and naturally includes issues of critical care capacity.


SNAP-2 findings rightly demonstrate there is a need to correctly identify which patients will and will not benefit from critical care which we would support as essential work.  We hope our current cross-specialty work on end of life care and escalation of treatment, and the findings from the Getting It Right First Time initiative on intensive and critical care, will add to our knowledge in this area.


The findings presented support the concerns raised by our members and partner organisations in the first report of the Critical Futures initiative. Clinicians are aware that we are dealing with higher risk patients who need a greater level of care than can be provided on a ward. The only safe place, usually, to provide this enhanced level of care is in a critical care environment, even though they do not meet the traditional requirements for level 2 care. This puts increased pressure on an already under resourced area and increases the risk of cancellation.


“The Faculty is undertaking work on developing a specification for enhanced care services. By developing enhanced care services we can provide safe care for high risk patients making efficient use of resources and ensuring patients receive the right level of care in the right place.


Interestingly those hospitals who have enhanced care areas see an increased risk of cancellation. This is likely because this care is seen as essential, and lack of availability means the surgery does not go ahead. In other hospitals, the patient would probably go to a ward, so there is less risk of cancellation but also lower quality care.  With a recognised national standard and improved commissioning, the availability of enhanced care and the consequent quality of patient care will both improve.”

Dr Alison Pittard, Vice Dean and Chair of the Enhanced Care Working Party


We look forward to further outputs from SNAP-2 that will hopefully present us with a more detailed picture of the current situation. 


“Our Critical Engagements report noted considerable regional variation in the provision of ICM staff and recruitment across the UK.  We need to ensure we recruit and retain sufficient staff  to meet the needs of the population in areas of the UK that are currently underprovided to ensure patients are getting access to critical care support when required.  Additional Critical Engagements indicated that larger units often lack the physical resources (e.g. staffed beds) to cope with increased demand. 


SNAP-2 findings demonstrate that the presence of an Emergency Department in the hospital increases the risk of cancellation.  This highlights the need for both (a) capacity and flow modelling for elective and emergency work, and (b) Critical care to be integral to any discussions regarding reconfiguration and service developments.  Critical Engagements indicated that involving local critical care leaders in these discussions  at an early stage led to a far better overall outcome: this was also the No. 1 recommendation of Critical Futures.  Involvement of Critical Care Clinical  Directors and Leads in the whole patient pathway is important in making an impact on cancellation rates.”

Dr Daniele Bryden, Chair of the Careers, Recruitment & Workforce Committee