Anaesthesia
Research and Quality Improvement
Research and Quality Improvement
Research and quality improvement are central to how our Departments of Anaesthesia, Intensive Care Medicine and Pain Medicine delivers safe, effective and compassionate care. Out work aims to ensure that evidence leads to safer systems, better outcomes and better experiences for patients.
Although a district general hospital, the RUH has a national and international reputation for research, audit leadership and quality improvement that rivals many university hospitals.
Research at the RUH
The department has a strong and sustained history of research activity spanning more than 25 years, particularly in areas where research has a direct impact on patient safety and clinical care.
In a bibliometric analysis of airway research publications, the RUH was ranked third best in the world, reflecting the quality, volume and influence of work produced by the department.
Key areas of research include:
- Airway management and airway equipment
- Resuscitation science
- Emergency laparotomy
- Patient safety and litigation in anaesthesia
Most members of the department are involved in academic publishing, and overall research output is on a par with, or exceeds, that of many university hospitals. Research activity is closely linked to quality improvement, ensuring that findings translate directly into changes in practice.
Pain services
The department has a strong track record in pain research, education and quality improvement, and works closely with academic and national partners. Pain services contribute to:
- Teaching and training for doctors, nurses and allied professionals
- Research and evaluation of pain management approaches
- Service development informed by patient feedback and outcomes
Academic Leadership
The department has strong academic leadership and links with the University of Bristol, Warwick and London. The department has three professors.
- Professor Tim Cook – with academic interests focusing on anaesthesia safety these include airway safety, awareness during anaesthesia, anaphylaxis, cardiac arrest, and litigation relating to anaesthesia. Airway advisor to the Royal College of Anaesthetists' and formerly Director of the Royal College of Anaesthetists' National Audit Projects (NAP).
- Professor Fiona Kelly – with research interests in human factors and safety education; creator of Tea Trolley Training, an innovative workplace teaching model adopted widely across the NHS to improve team learning and patient safety.
- Professor Jerry Nolan – an international authority in resuscitation medicine; Professor of Resuscitation Medicine whose research and guideline contributions have influenced cardiac arrest and resuscitation care globally.
National and International Research Activity
Between 2021 and 2025, the department has participated in a wide range of major national and international studies and audits, including:
NAP6, NAP7, SNAP1, SNAP2, SNAP3, PQIP, FLO-ELA, GAP, GLIMPSE, VITAL, POPPY, REMAP-CAP, RECOVERY, GenOMICC, SHORTER, MARCH, GuARDS, ABRUPT, AIRWAYS-3, and Bath-MAT. Future research projects include NAP8, EXTUBE and SECURE.
We also perform well in the national emergency laparotomy audit (NELA). In the Year 8 report (Jan 2024) we were the only hospital listed with the best UK outcome.
The department was the first in the UK, and probably the second globally, to introduce Universal Video-laryngoscopy (in 2015). The department has described this process in several publications and produced multiple publications from a unique video-laryngoscopy database.
Departmental members have undertaken systematic reviews and meta-analyses highlighting the benefits of video-laryngoscopy. The department has actively supported other departments considering similar changes. This research and leadership have contributed notably to national changes in practice, culminating in the national recommendations for Universal Video-laryngoscopy.
Research Infrastructure and Priorities
Research at the RUH is embedded within clinical services and supported by strong multidisciplinary collaboration and support form dedicate Research Nurses in anaesthesia and Intensive Care.
The department takes an active role in NIHR portfolio research.
The department aims to actively support trainees in research including trainee-led research and service evaluation.
Research-interested trainees are encouraged to get involved, either through their own ideas or by contributing to ongoing projects. We are proud to host regular CR&I fellows from the Royal College of Anaesthetists invovled in leading national research and audits as well as supporting research and QI at the RUH.
Quality Improvement and Patient Safety
Quality improvement (QI) is a defining strength of the department and underpins many of our clinical achievements. We have a long track record of using structured improvement methods to enhance patient safety, outcomes and experience.
Many of the department are trained in quality improvement methodology, led by national award-winning leaders. The team supports leadership, mentorship and oversight for improvement work across the department and trust.
Quality Improvement Training
QI is formally embedded within the resident doctors teaching programme, and many consultants are accredited QI practitioners. A key element of training is the QSIR (Quality Service Improvement and Redesign) programme, a nationally recognised course originally developed by NHS Improvement and now led by AQUA. This is free to all members of the trust.
- A 4-day programme delivered over 2–3 months at the RUH
- Led locally by Dr Lesley Jordan, Consultant Anaesthetist
- Combines formal teaching with delivery of a live QI project
- Leads to QSIR Practitioner accreditation
The programme is open to all RUH staff and is particularly popular with anaesthetic trainees. Many participants have gone on to lead high-impact and successful QI projects locally and nationally.
National Quality Improvement Leadership
The department plays an active role in national QI and audit initiatives, including:
- The National Emergency Laparotomy Audit (NELA)
Using NELA data and QI methodology, the RUH has significantly improved care for patients undergoing emergency abdominal surgery. The Trust is a positive national outlier for mortality, achieving the lowest mortality rates nationally in:
This work has been published in the journal Anaesthesia and shared nationally through presentations to other Trusts.
The department has also been heavily involved in the Anaesthetic National Audit Projects (NAP), with departmental members contributing at a national level, particularly through the leadership of Prof Tim Cook.
Local Innovation and National Recognition
The department has a strong history of innovative local QI projects that have been widely shared and adopted.
A notable example is Tea Trolley Training, created by Prof Fiona Kelly, an innovative approach to workplace-based education and safety training that has spread to hospitals across the UK and was shortlisted for the Patient Safety Care Awards and HSJ Awards.
The department has also:
- Won a HSJ Patient Safety Award (2014) for prevention of perioperative hypothermia
- Been shortlisted multiple times for national Patient Safety Awards between 2014 and 2023
Benefits of research and quality improvement
For patients, our research and quality improvement work means:
- Care by staff actively involved in research and use of the best available evidence
- Systems designed with the aim of reducing risk and improving safety
- Active engagement in local and nations research and quality improvement processes, which is known to improve the quality of overall care
For staff and trainees, it means:
- a research environment that welcomes challenge, engagement and asking of questions
- support to develop research and improvement skills
- opportunities to lead meaningful change