Each year the Royal College of Anaesthetists undertakes a national audit project of procedures and practices within the specialty that have the potential to be associated with significant morbidity and mortality. The fourth National Audit Project (NAP4), endorsed by the Difficult Airway Society, audited advanced airway management and its complications in general theatres, labour wards, critical care units and emergency departments. The NAP4 data allowed the authors to benchmark their own practice against national standards. Using the recommendations in NAP4 they developed a quality improvement intervention to improve airway assessment and tracheal intubation procedures. The authors used a multidisciplinary team approach to training, improving resources and adopting new working practices, which resulted in improved endotracheal intubation technique, and embedded new practice and a new departmental training programme.